Family Ties of Nevada Monthly Webinar Series Thursday, April 12, 2012

Wendy Jones April 12, 2012 C ULTURAL C OMPETENCE : W HAT DOES IT MEAN FOR FAMILY RESOURCE CENTERS AND THEIR P ARTNERS ? National Center for Cultural Competence

OBJECTIVES Slide Source: © National Center for Cultural Competence Participants will: 1.define culture and cultural diversity. 2.describe the multiple dimensions of culture including cultural influences on individuals, groups, and organizations. 3.cite cultural influences on beliefs and practices related to health, mental health, well-being and systems and providers of health and human services. 4.examine and apply these cultural constructs to their respective roles and affiliations.

Culture is…… Culture is a complex set of shared values, beliefs, understandings, behaviors, language, customs, activities, rites and rituals that guide specific groups of people. Culture includes a range of ideas about family, aspects of family life, wellness, disability, child rearing practices, interpersonal relationships and expectations for learning and child development. Culture changes over time, and is passed down from one generation to the next. Slide Source:© National Center for Cultural Competence

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

Culture Culture is akin to being the person observed through a one-way mirror; everything we see is from our own perspective. It is only when we join the observed on the other side that it is possible to see ourselves and others clearly – but getting to the other side of the glass presents many challenges. (Lynch & Hanson 1992 Developing Cross Cultural Competence) Slide Source: National Center for Cultural Competence

Culture … is applicable to all peoples is active & dynamic is multi-layered is viewed as thick, thin, or compartmentalized exists at conscious and unconscious levels structures perceptions & shapes behaviors is a total way of life – tells group members how to behave & provides their identity Adapted from Vivian Jackson, NCCC, 2003 Slide Source:© National Center for Cultural Competence

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

Are we on the same page? culturally aware cultural sensitivity culturally appropriate culturally effective culturally relevant culturally competent cultural humility culturally & linguistically competent linguistically competent cultural proficiency multicultural competence T.D. Goode Slide Source:© National Center for Cultural Competence culturally relevant cultural responsiveness linguistically appropriate

policiespracticesbehaviorsstructuresattitudes …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 & Isaacs, CULTURAL COMPETENCE Slide Source:© 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:© National Center for Cultural Competence

1 value diversity 2 conduct self-assessment 3 manage the dynamics of difference 4 institutionalize cultural knowledge 5 adapt to diversity (values, polices, structures & services) Five Elements of Cultural Competence ORGANIZATIONAL LEVEL (Cross, Bazron, Dennis and Isaacs, 1989) Slide Source:© National Center for Cultural Competence

Organization culture is … a pattern of shared basic assumptions that the group learned as it solved its problems of external adaptation and internal integration, that has worked well enough to be considered valid and therefore, to be taught to new members as the correct way to perceive, think, and feel in relation to those problems. (Schein, E., 1985) Slide Source: © 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:© National Center for Cultural Competence

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

is the capacity of an organization and its personnel to communicate effectively, and convey information in a manner that is easily understood by diverse groups including persons of limited English proficiency, those who are not literate or have low literacy skills, individuals with disabilities, or those who are deaf or hard of hearing requires organizational and provider capacity to respond effectively to the health literacy needs of populations served ensures policy, structures, practices, procedures and dedicated resources to support this capacity Linguistic Competence Goode & Jones, Revised 2009, National Center for Cultural Competence Slide Source:© National Center for Cultural Competence

Slide Source: National Center for Cultural Competence,2007 Linguistic Competence Goode & Jones, Revised 2009, National Center for Cultural Competence bilingual/bicultural or multilingual/multicultural staff cross-cultural communication approaches cultural brokers foreign language interpretation services (including distance technologies) sign language interpretation service multilingual telecommunication systems Videoconferencing & telehealth technologies TTY, CART, VRT and other assistive technology devices

Slide Source: National Center for Cultural Competence,2007 Linguistic Competence Goode & Jones, Revised 2009, National Center for Cultural Competence materials in alternative formats (e.g. audiotape, Braille, enlarged print) materials developed and tested for specific cultural groups, ethnic and linguistic groups ethnic media in languages other than English (e.g. television, radio, Internet, newspapers, periodicals) print materials in easy to read and low literacy formats (e.g. picture and symbol formats)

LINGUISTIC COMPETENCE POLICY PRACTICES STRUCTURESPROCEDURES DEDICATED PERSONNEL RESOURCES DEDICATED FISCAL RESOURCES LINGUISTIC COMPETENCE FRAMEWORK Goode & Jones, Revised 2009, National Center for Cultural Competence Slide Source:© National Center for Cultural Competence

Key Values for Cultural Competence Values and Guiding Principles for Cultural Competence Cultural competence:  embraces the principles of equal access and non- discriminatory practices in service delivery.  is achieved by identifying and understanding the needs and help-seeking behaviors of individuals and families.  involves working in conjunction with natural, informal support and helping networks within culturally diverse communities. Source: National Center for Cultural Competence, Foundations/Guiding Values and Principles Slide Source: National Center for Cultural Competence, 2012

Key Values for Linguistic Competence Values and Guiding Principles for Linguistic Competence  Services and supports are delivered in the preferred language and/or mode of delivery of the population served.  Written materials are translated, adapted, and/or provided in alternative formats based on the needs and preferences of the populations served.  Interpretation and translation services comply with all relevant Federal, state, and local mandates governing language access.  Consumers are engaged in evaluation of language access and other communication services to ensure for quality and satisfaction. Source: National Center for Cultural Competence, Foundations/Guiding Values and Principles Slide Source: National Center for Cultural Competence, 2012

Cultural Diversity and Differing World Views

Cultural Diversity Goode & Jackson, 2009 The term cultural diversity is used to describe differences in ethnic or racial classification & self-identification, tribal or clan affiliation, nationality, language, age, gender, sexual orientation, gender identity or expression, socioeconomic status, education, religion, spirituality, physical and intellectual abilities, personal appearance, and other factors that distinguish one group or individual from another. Slide Source: © National Center for Cultural Competence

What are the demographic trends in Slide Source:© National Center for Cultural Competence

Religious Affiliations* Nevada Religious AffiliationNumber of Adherents Evangelical Protestant107,681 Mainline Protestant44,187 Orthodox3,048 Catholic331,844 Other Includes Jewish Estimate. - 77,100 Includes Muslim Estimate. – 2, ,729 Unclaimed by the denominations in this archive 1,313,768 Source: The Association of Religion Data Archives, *Archives188 denominations. Does not include historically African American denominations.

Top 10 Countries of Birth and State of Residence of Permanent Residents in Nevada Mexico Philippines Cuba China Ethiopia El Salvador India Vietnam Guatemala Canada 2,586 2, Data Source: Department of Homeland Security: Profiles of Legal Permanent Residents: Fiscal Year 2010 Total56,920 Slide Source:© National Center for Cultural Competence

Population by Race & Ethnicity in Nevada Total Population 2,700,551 White Hispanic or Latino Black or African American Asian American Indian and Alaska Native Native Hawaiian and Other Pacific Islander Some other race Two or more races Data Source: U.S. Census Bureau, 2010 American FactFinder Table QT-P4 1,786, , , ,436 32,062 16, , ,075 Slide Source:© National Center for Cultural Competence

Languages Spoken at Home in Nevada English only 1,797,807 Total other languages 720,129 Speak Spanish or Spanish Creole 503,220 Speak Indo European languages 61,352 [French (Patois, Cajun), French Creole, Italian, Portuguese, Portuguese Creole, German, Yiddish, Other West Germanic languages, Scandinavian languages, Greek, Russian, Polish, Serbo-Croatian, Other Slavic languages, Armenian, Persian, Gujarathi, Hindi, Urdu, Other Indic languages] Speak Asian and Pacific Island languages 137,128 [Chinese, Japanese, Korean, Mon-Kymer, Cambodian, Miao, Hmong, Thai, Laotian, Vietnamese, Tagalog, other Pacific Island language] Other Languages 17,291 [Navajo, Other Native American languages, Hungarian, Arabic, Hebrew, African languages, other unspecified languages] Data Source: U.S. Census Bureau, 2010 American FactFinder Total Population 5 years and over 2,517,937 Slide Source:© National Center for Cultural Competence

What is Linguistic Isolation ? Linguistic Isolation refers to households in which no person over the age of 14 speaks English at least very well Data Source: U.S. Census Bureau, 2010 American FactFinder Table S1 Linguistically Isolated Households in Nevada All Households 6.4% Households speaking -- Spanish 26.5% Other Indo-European languages 14.5% Asian and Pacific Island languages 18.9% Other Languages 27.6% Slide Source:© National Center for Cultural Competence

Cultural Factors That Influence Diversity Among Individuals and Groups Adapted with permission from James Mason, Ph.D., NCCC Senior Consultant Cultural/Racial/Ethnic Identity Tribal Affiliation/Clan Nationality Acculturation/Assimilation Socioeconomic Status/Class Education Language Literacy Family Constellation Social History Perception of Time Health Beliefs & Practices Literacy Internal Factors Health & Mental Health Literacy Beliefs about 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 Slide Source:© National Center for Cultural Competence

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

 Superstition  Fate or Destiny  Karma  Malevolent Forces  Religiosity & Spirituality  Cultural & Familial Folklore Slide Source:© National Center for Cultural Competence Cultural Beliefs about Health, Mental Health, & Disability

Reliance on traditional remedies and healers Culture bound syndromes Delaying access to care Historical mistrust of health care, mental health, education, and social service professionals Experiences of racism, discrimination, and bias Cultural and linguistic barriers Stigma Cultural Influences on Beliefs and Practices Related to Systems and Providers of Human Services T.D. Goode Slide Source:© National Center for Cultural Competence

What does cultural competence look like

philosophy mission statement policy, structures, procedures, practices diverse, knowledgeable & skilled workforce dedicated resources & incentives community engagement & partnerships conduct research for and with diverse communities publish & disseminate advocacy (disparities, health equity, social justice) Characteristics of Culturally and Linguistically Competent Organizations and Systems Slide Source:© National Center for Cultural Competence

Cultural Competence: Staff Characteristics, Attributes, Knowledge, & Skills  demonstrate genuine interest  admit & identify areas of growth  willingness & skills to address the dynamics of difference  seek knowledge Slide Source:© National Center for Cultural Competence T. D. Goode

Cultural Competence: Staff Characteristics, Attributes, Knowledge, & Skills The capacity to incorporate cultural diversity and cultural competence into your work, such as: Providing family-centered care Connecting with families Providing educational opportunities Linking families for peer to peer support Sharing information and making referrals Supporting self-advocacy efforts Advising and partnering Slide Source:© National Center for Cultural Competence T. D. Goode

As a culturally competent _________ I am capable of interacting positively with people who do NOT look like, talk like, think like, believe like, act like, live like... ME!!! Source Multnomah County Department of Health. move like, Modification from Mike Magy, Massachusetts Department of Mental Health, November Slide Source:© National Center for Cultural Competence

Cultural competence and linguistic competence are a life’s journey … not a destination Safe travels! T.D. Goode Slide Source: National Center for Cultural Competence, 2012

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