1. Second World Congress on Spina Bifida Research and Care Health Issues for Latinos with Spina Bifida Las Vegas, NV March 13, 2012

2. Introduction to Cultural Proficiency Magdalena Castro Lewis Director, Center for Community Services National Alliance for Hispanic Health

3. Vision: Strong healthy communities whose contributions are recognized by a society that fosters the health, well- being, and prosperity of all its members. Mission: Improve the health of Hispanic communities and work with others to secure health for all. We are unique: Since 1973 represent all Hispanic groups. Dedicated to community-based solutions. No funds from tobacco or alcohol companies. Reputation: Nation’s foremost information source and advocate for Hispanic health.

4. Alliance members are… Organizations National Community-based For-profit corporations Foundations Government Hospitals Universities Individuals Professionals Consumers Students Retirees

5. Purpose This session is intended to provide basic information on cultural proficiency to health and human service professionals delivering services to children with spina bifida and their families.

6. Agenda Rationale for cultural proficiency in the delivery of cross-cultural services. How values, beliefs and attitudes influence health and delivery of services. A cultural proficiency model

7. Rationale for Culturally Proficient Health Care Health Care Complying with legislative, regulatory, and accreditation mandates Responding to demographics Reducing cost and improving the quality of services and outcomes Adapted from; Cohen E, Goode T. Policy Brief 1: Rationale for Cultural Proficiency in primary health care. Georgetown University Child Development Center, The National Center for Cultural Proficiency. Washington, D.C., 1999.

8. Mandates and Regulations National Standards C.L.A.S Federal Law Title VI EO 13166 The Hill-Burton Act Medicaid Medicare Federal Categorical Grant Programs Emergency Medical Treatment and Active Labor Act State Laws Private Sector

9. Hispanic Population in the U.S. One out of six people in the U.S. is Hispanic Hispanic Pop. 50.4 million Puerto Rico 3.7 million Total: 54.1 million Source: U.S. Census Bureau. Overview of Race and Hispanic Origin:2010, March 2011. Annual Estimates of the Resident Population for Municipios of Puerto Rico: April 1, 2000 to July 1, 2009, (PMR-EST2009-01), March 2010. and, U.S. Census Bureau, 2010 Census Redistricting Data (Public Law 94-171) Summary File, Table P1.

10. Note: Figures do not include the Commonwealth of Puerto Rico. American Indian proportion is less than 1 percent. Source: U.S. Bureau of the Census, Population Division. Percent of the Projected Population by Race and Hispanic Origin for the United States: 2010 to 2050 (NP2008-T6) August 14, 2008

11. Women’s rate of having children with spina bifida Source: Centers for Disease Control. (2011). Spina Bifida Data and Statistics. Retrieved from http://www.cdc.gov/ncbddd/spinabifida/data.html http://www.cdc.gov/ncbddd/spinabifida/data.html

12. Improving Quality of Services and Outcomes Nearly half (45%) of uninsured Spanish speaking Hispanic patients reported problems communicating with their doctor, compared to 28% of uninsured whites, and 30% of uninsured African Americans. 1 Only 33.8% of adult Hispanics aged 40 and over with diabetes received three recommended annual screenings – foot exams, eye exams, and A1C tests – compared with 42.4% of non-Hispanic whites. 2 Rate of potentially preventable hospital stays among Hispanic adults is more than double that for non-Hispanic white adults (37 vs. 17 hospitalizations per 10,000 population). 3 1 Doty, Michelle M. Hispanic Patients’ Double Burden: Lack of Health Insurance and Limited English. The Commonwealth Fund, 2003. 2 Agency for Healthcare Research and Quality (AHRQ). 2008 National Healthcare Disparities Report. AHRQ Pub. No. 09-0002; 49-50. U.S. Department of Health and Human Services, AHRQ, Rockville, MD, 2009. 3 E. Stragnes et al., Potentially Preventable Hospital Stays Among Hispanics, 2006. HCUP Statistical Brief #61 (2008). Agency for Healthcare Research and Quality (AHRQ), Rockville, MD, 2008.

13. About Culture The word ”culture” implies patters of human behavior including thoughts, actions, customs, values, and beliefs that can bind a racial, ethnic, religious or social group within a society. It is Challenging for individuals to recognize and change their own cultural practices.

14. Culture affects our health decisions Such decisions are strongly influenced by the ideas, beliefs, and customs passed down to us through our families, traditions and cultural groups.

15.  Individual- “the ability to use knowledge and communication skills to work effectively with people of different cultures… the state of being capable of functioning effectively in the context of cultural differences”  Organizational- “the integration of behaviors, skills, attitudes, policies and procedures which will come together in a system to enable people to work effectively across cultures” What is Cultural Proficiency?

16. Cultural Proficiency comprises four components a. Awareness of one's own cultural worldview b. Attitude towards cultural differences c. Knowledge of different cultural practices and worldviews d. Cross-Cultural Skills / Abilities

17. A Cultural Proficiency Model Example

18. Cultural Destructiveness Destructive to cultures Cultural Incapacity No capacity to help clients from other cultures Cultural Blindness Predominant system..philosophy to being unbiased Cultural Pre-competence Movement toward reaching out to other cultures Cultural Competency Acceptance of and respect for differences Cultural Proficiency Holding culture in high esteem Towards Cultural Proficiency Adapted with permission from: Cross, T.L., Bazron, K.W., Dennis, and M.R. Isaccs. 1989; p. 13.

19. Towards Cultural Proficiency Cultural Destructiveness “No desire” Attitude, policies and practices that are destructive to cultures and the individuals within these cultures. Cultural Incapacity “No capacity” Agencies do not intentionally seek to be culturally destructive but rather have no capacity to help clients from other cultures.

20. Toward Cultural Proficiency Cultural Blindness “One size fits all” Agencies provide services with the express philosophy of being unbiased. Color or culture makes no difference. Cultural Pre-Competence “Moving forward” Implies movement towards reaching out to other cultures. Attempt to improve services. Desire to deliver quality services.

21. Toward Cultural Proficiency Culturally Competent “Experts in the field” Acceptance of and respect for difference, continuing self assessment regarding culture, expansion of cultural knowledge and resources, adaptations of service models. Culturally Proficient “Leaders of the pack” Highest level of performance and refers to excellence and sustained commitment in addressing cross-cultural issues. Agencies hold culture in high esteem.

22. Final Message Cultural proficiency is not a static point. Periodic assessments, initiatives for change, and training / education are necessary to achieve and sustain personal and/or organizational cultural proficiency.

23. Resources Su Familia: The National Hispanic Family Health Helpline (1-866 SU Familia) 1-866-786-2645 Delivering Health Care to Hispanics. A Manual for Providers. National Alliance for Hispanic Health. ww.hispanichealth.org ww.hispanichealth.org Office of Minority Health www.omhrc.govwww.omhrc.gov National Standards on Culturally and Linguistically Appropriate Services (CLAS) http://www.minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=15 Health Resources and Services Administration (HRSA) www.hrsa.gov/culturalcompetence

24. Any Questions? ¡Gracias! www.hispanichealth.org

25. Considering Hispanic/Latino Core Values

26. Hispanic/Latino Core Values Respeto Confianza Personalismo

27. Respeto / Respect Based on age, sex, social position, position of authority Reciprocal

28. Personalismo/Personalism Personal versus impersonal Individual versus institution Family values

29. Confianza/Trust Trust developed over time Based on relationships