Culturally Responsive Practice: Every Day, in Every Way Creating Partnerships within the Context of Culture Suzanne M. Bronheim, Ph.D., National Center for Cultural Competence Mercedes Rosa, Statewide Parent Advocacy Network Dee Spinkston, Urban PRIDE Strand Presentation 309(317)

National Center for Cultural Competence Georgetown University Center for Child and Human Development University Center of Excellence in Developmental Disabilities

Culture Culture is an integrated pattern of human behavior which includes but is not limited to: roles values rituals communication languages relationships courtesies thought beliefs practices customs manners of interacting expected behaviors … of a racial, ethnic, religious, social, or political group; the ability to transmit the above to succeeding generations; dynamic in nature. Slide Source: The National Center for Cultural Competence, 2007 Slide Source: National Center For Cultural Competence ©2011

Cultural Factors That Influence Diversity Among Individuals and Groups Internal Factors Health Literacy Perception of Disability or Mental Health Lived Experience of Disability or Mental Illness Age & Life Cycle Issues Gender, Gender Identity & Expression Sexual Orientation Religion & Spiritual Views Spatial & Regional Patterns Political Orientation/Affiliation Cultural/Racial/Ethnic Identity Tribal Affiliation/Clan Nationality Acculturation/Assimilation Socioeconomic Status/Class Education Language Literacy Family Constellation Social History Perception of Time Health/Mental Health Beliefs & Practices Adapted with permission from James Mason, Ph.D., NCCC Senior Consultant Slide Source:© 2010 - National Center for Cultural Competence

Cultural Factors That Influence Diversity Among Individuals and Groups External Factors Institutional Biases Racism & Discrimination Community Economics Intergroup Relations Group & Community Resiliency Natural Networks of Support Community History Political Climate Workforce Diversity Community Demographics Adapted with permission from James Mason, Ph.D., NCCC Senior Consultant Slide Source:© 2010 - National Center for Cultural Competence

Culture as Lens Our beliefs, values, experiences and cultural expectations create a lens that gives meaning to our world. Each lens is different and all interactions are somewhat cross-cultural. Slide Source:© 2010 - National Center for Cultural Competence

An Iceberg Concept of Culture dressage gender  language  race or ethnicity  physical characteristics eye behavior  facial expressions  Adapted by the NCCC  body language sense of self   gender identity  notions of modestyconcept of cleanliness  emotional response patterns rules for social interaction child rearing practices  decision-making processes  approaches to problem solving   concept of justice value individual vs. group   perceptions of mental health, health, illness, disability   patterns of superior and subordinate roles in relation to status by age, gender, class  sexual identity & orientation  and much more… Slide Source:© 2010 - National Center for Cultural Competence

Creating Partnerships within the Context of Culture Need a shared “lens” on: Is there a problem? What is the problem? What are the choices? What principles guide the choices? Who are the decision makers? What are the roles of the “team”? Slide Source:© 2010 - National Center for Cultural Competence

Definition & Framework Cultural Competence Definition & Framework

(adapted from Cross, Bazron, Dennis and Isaacs, 1989) Cultural Competence behaviors attitudes policies structures practices requires that organizations have a clearly defined, congruent set of values and principles, and demonstrate behaviors, attitudes, policies, structures, and practices that enable them to work effectively cross-culturally (adapted from Cross, Bazron, Dennis and Isaacs, 1989) Slide Source:© 2010 - National Center for Cultural Competence Slide Source:© 2011 - National Center for Cultural Competence

Five Elements of Cultural Competence Organizational Level value diversity conduct cultural self-assessment manage the dynamics of difference institutionalize cultural knowledge adapt to diversity - policies - structures - values - services (Cross, Bazron, Dennis and Isaacs, 1989) Slide Source:© 2010 - National Center for Cultural Competence

Five Elements of Cultural Competence Individual Level acknowledge cultural differences understand your own culture engage in self-assessment acquire cultural knowledge & skills view behavior within a cultural context (Cross, Bazron, Dennis and Isaacs, 1989) Slide Source:© 2011 - National Center for Cultural Competence Slide Source:© 2011 - National Center for Cultural Competence

ESSENTIAL ELEMENTS IN A CULTURALLY COMPETENT SYSTEM These five elements must be manifested at every level of an organization including: policy makers administration practice & service delivery patient/family/consumer community and reflected in its attitudes, structures, policies, practices, and services. Adapted from Cross, Bazron, Dennis, & Isaacs, 1989 Slide Source:© 2010 - National Center for Cultural Competence

What Cultural Competence is Not Cookbook approaches to specific racial or ethnic groups Translating materials into other languages as the only action Making alterations in programs/approaches at one point in time Treating everyone the same Only the concern of providers/employees Slide Source:© 2010 - National Center for Cultural Competence

Cultural Competence Continuum (Cross, Bazron, Dennis and Isaacs, 1989) Cultural Proficiency Cultural Competence Cultural Pre-Competence Cultural Blindness Cultural Incapacity Cultural Destructiveness Slide Source:© 2010 - National Center for Cultural Competence

Definition of Linguistic Competence The capacity of an organization and its personnel to communicate effectively, and convey information in a manner that is easily understood by diverse audiences including persons of limited English proficiency, those who have low literacy skills or are not literate, individuals with disabilities, and those who are deaf or hard of hearing. Linguistic competency requires organizational and provider capacity to respond effectively to the health and mental health literacy needs of populations served. The organization must have policy, structures, practices, procedures, and dedicated resources to support this capacity. Goode & Jones (modified 2009). National Center for Cultural Competence, Georgetown University Center for Child & Human Development. Slide Source:© 2011 - National Center for Cultural Competence

What will it take to create partnerships in a cultural context? Programs/service and support organizations Systems and organizations must sanction, and in some cases mandate the incorporation of cultural knowledge into policy making, infrastructure and practice.* Cultural competence embraces the principles of equal access and non-discriminatory practices in service delivery * Adapted from Cross, T. et al, 1989 Slide Source:© 2010 - National Center for Cultural Competence

What will it take to create partnerships in a cultural context? Programs/service and support organizations identify and understand the needs and help-seeking behaviors of individuals and families.* design and implement services that are tailored or matched to the unique needs of individuals, children, families, organizations and communities served.* provide services driven by client preferred choices, not by culturally blind or culturally free interventions.* * Adapted from Cross, T. et al, 1989 Slide Source:© 2010 - National Center for Cultural Competence

What will it take to create partnerships in a cultural context? Professionals, administrators, program staff: Examine and know own cultural values Elicit information about family and cultural beliefs, values and concerns related to the focus of the partnership Include cultural considerations in all service plans, program development, program evaluation Know natural support networks in community served Know how and families view community services and supports Slide Source:© 2010 - National Center for Cultural Competence

What will it take to create partnerships in a cultural context? Professionals, administrators, program staff: Get regular feedback from families about the process of partnership and the outcomes –services and supports

What will it take to create partnerships in a cultural context? Families and youth Identifying your values and beliefs Providing information to professionals, program staff or other partners about what you think a problem might be, acceptable solutions, key decision makers, roles for you, your child/youth, others, providers Slide Source:© 2011 - National Center for Cultural Competence

What will it take to create partnerships in a cultural context? Families and youth Identifying authorities/cultural brokers in your cultural community to help inform providers Learning to talk about culture Slide Source:© 2011 - National Center for Cultural Competence

What will it take to create partnerships in a cultural context? Family organizations Examine and know own cultural values Elicit information from families about cultural beliefs, values and concerns Include cultural considerations in your intake procedures Know natural support networks in community served Know how families view community supports Slide Source:© 2011 - National Center for Cultural Competence

What will it take to create partnerships in a cultural context? Family organizations Elicit information about families views on advocacy Don’t challenge authority Experiences of discrimination and bias Experiences of trauma Immigration issues even if documented Support needs for language access within your organization and with providers Advocate for systems to address cultural issues Be a champion Slide Source:© 2011 - National Center for Cultural Competence

What will it take to create partnerships in a cultural context? Family organizations Assess your awareness, knowledge and skills Advocates that reflect the diversity of the community served Address language access Dynamics of difference—build skills Partner with support networks in community served Policies to support cultural and linguistic competence Slide Source:© 2011 - National Center for Cultural Competence

Cultural and linguistic competence is a life’s journey … not a destination Safe travels! Slide Source:© 2011 - National Center for Cultural Competence

Cultural Competence with Immigrant & LEP Families: A Parent Organization Perspective Presented by Mercedes Rosa, Project Director Family to Family Health Info Center CHIPRA Immigrant Outreach & Enrollment Project Culturally Competent Outreach & Support Project Statewide Parent Advocacy Network (SPAN)

SPAN’s Mission To empower families & inform & involve professionals & others interested in the healthy development & education rights of children, to enable them to become fully participating & contributing members of our communities & society.

SPAN’s Commitment SPAN’s foremost commitment is to children with the greatest need due to disability, special health or mental health needs; poverty; discrimination based on race, sex, language, or immigrant status; geographic location; or family or other special circumstances

SPAN’s Motto & Focus Empowered Parents: Educated, Engaged, Effective! Focus = enhance the leadership of every parent Within their family Within their community In systems change

Strengths-based Parent leadership development thru peer-to-peer education, support & empowerment Parents can be leaders regardless of their current situation

Strengths-based We build leadership, not dependence We measure our effectiveness in enhancing family confidence, competence, attitudes & skills We ask families to assess our work

Engage families at all levels We routinely ask, listen to, & incorporate the voices of diverse families in: Our programs & services Policy Development We provided needed supports “Nothing about me, without me.”

Language access Multi-lingual staff Community partnerships Language Line Website translation Traducelo Ahora Websites Emails

Cultural reciprocity Developing reciprocal relationships of trust with families Asking families what will work for them “Do unto others as they would have you do unto them.” “Seek first to understand, then to be understood.”

Cultural Brokers Identify partners with legitimacy with families & targeted communities. Develop reciprocal trusting relationships

Self-Assessment Conduct cultural & linguistic competence self-assessment using NCCC tool Conduct language access assessment Develop improvement plans

Self-Assessment Collect & analyze data based on race, language, etc. to measure effectiveness & to identify the need for policy improvements

Flexibility Provide information & training at convenience times & locations, in multiple languages & formats

Targeted services Target families from underserved communities for more intensive supports designed to be flexible & responsive to their specific needs

Catalyst for Change Helping education, health, and other service delivery systems: Recognize the barriers for families Make changes to address barriers Engage families in all processes

Commitment People say, what is the sense of our small effort. They cannot see that we must lay one brick at a time, take one step at a time. A pebble cast into a pond causes ripples that spread in all directions. Each one of our thoughts, words and deeds is like that. No one has a right to sit down and feel hopeless. There’s too much work to do.