1. AN INTRODUCTION TO DEVELOPING CULTURAL COMPETENCIES Centra Wellness Network

2. SOMETHING TO THINK ABOUT  If we could shrink the earth’s population to a village of 100 people, all the existing human ratios remaining the same, there would be:  57 Asians  21 Europeans  8 Africans  52 Females  48 Males  70 Non-Whites  30 White  89 Heterosexual  11 Homosexual  6 have 59% of the world’s wealth  80 would live in substandard housing  70 would be illiterate  50 would suffer from malnutrition  1 would own a computer  1 would have a college education  When one considers this, the need for acceptance, understanding and education becomes evident.

3. LEARNING OUTCOMES FOR DEVELOPING CULTURAL COMPETENCIES  Learn why cultural competence is important  Learn what cultural competence means  Learn how to develop cultural competencies

4. WHY IS DEVELOPING CULTURAL COMPETENCIES IMPORTANT?  If Mental Health services are not culturally competent, it may lead to: –Delay in seeking treatment –Misdiagnosis –Early termination of treatment and/or failure to follow recommendations  If Mental Health services are culturally competent: –Treatment will be more effective –The individual’s cultural beliefs and values will be integrated into the person centered plan

5. WHAT IS CULTURE?  “Culture is the accumulation of a shared pattern of values, attitudes, roles, assumptions, and behaviors that help us function in a particular context.” Ka’opua, 1994

6. THE EFFECT OF CULTURE  “Culture is tightly interwoven into the life of man and continually pervades his thinking, actions, feelings and particularly his health state.” Leininger 1967

7. AGE RACE SEXUAL ORIENTATION GENDERETHNICITY PHYSICAL QUALITIES RELIGIOUS BELIEFS EDUCATION PARENTAL STATUS INCOME WORK BACKGROUND MARITAL STATUS GEOGRAPHICAL LOCATION MILITARY EXPERIENCE Loden & Rosener

8. NONETHNIC CULTURES  Bureaucratic culture  School culture  Business culture  HealthCare culture  Disability culture  Religious Culture  Gay culture  Drug culture  Poverty culture

9. A PARADIGM SHIFT  From assimilation in“the melting pot” to respect for diversity in the “salad bowl”

10. WHAT IS CULTURAL COMPETENCE?  “The term cultural competence means services, supports, or other assistance that are conducted or provided in a manner that is responsive to the beliefs, interpersonal styles, attitudes, language and behaviors of individuals who are receiving services, and in a manner that has the likelihood of ensuring their maximum participation in the program.” (DD Assistance & Bill of Rights Act, 1994)

11. PROCESS OF CULTURAL COMPETENCE CULTURAL AWARENESS CULTURAL KNOWLEDGE CULTURAL SKILL CULTURAL ENCOUNTERS CULTURAL DESIRE Bacote

12. CULTURAL AWARENESS  “The deliberate, cognitive process in which health care providers become appreciative and sensitive to the values, beliefs, lifeways, practices and problem solving strategies of clients’ cultures” Bacote

13. CULTURAL KNOWLEDGE  “The process of seeking and obtaining a sound educational foundation concerning the various world views of different cultures.”  “Also knowledge of specific physical, biological and physiological variations among ethnic groups.” Purnell

14. CULTURAL ENCOUNTERS  “Engaging directly in cross- cultural interactions with clients from culturally diverse backgrounds.”  “Being aware of intra- ethnic variations within a cultural group.” Bacote

15. CULTURAL SKILL  Is the ability to collect relevant cultural data regarding the client’s health histories and presenting problems…by accurately and sensitively performing a culturally based assessment Bacote

16. THE LEARN MODEL  “IT COMES DOWN TO LISTENING TO THE CLIENT AND FINDING WHAT WORKS FOR THEM AND WHAT DOESN’T.” Ka’poua 1994

17. CONHFER MODEL A FRAMEWORK FOR ASSESSING CULTURE  Communication Style  Orientation  Nutrition  Family Relationships  Health Beliefs  Education  Religion Fong 1985

18. CULTURAL ASSESSMENT WITH OPEN ENDED QUESTIONS  What do you think caused your problem?  Why do you think it started when it did?  What do you think your illness does to you?  What kind of treatment do you think you should receive?  What are the most important results you hope to achieve?  What are the chief problems your illness has caused?  What do you fear most about your illness? (Kleinman etal 1978)  What do you expect of me? ( Bacote, 1998)l

19. CULTURAL DESIRE  “The motivation of health care providers to “want to” engage in the process of cultural competence.” Bacote  “People do not care how much you know, until they know how much you care.”

20. CULTURALLY APPROPRIATE SERVICES  “Clients must also find healthcare services culturally appropriate and be willing to adopt them as their own. Failure of the client to see the service as appropriate can lead to non- compliance. Non-compliance is not a client problem, but the failure of healthcare providers to provide culturally appropriate care” Bacote pg.45

21. A CULTURALLY COMPETENT MENTAL HEALTH SYSTEM  A culturally competent mental health system incorporates skills, attitudes and policies to ensure that it is effectively addressing the treatment and psychosocial needs of consumers and families with diverse values, beliefs, and sexual orientations, in addition to backgrounds that vary by race, ethnicity, religion, and/or language. (NMHA Position Statement)

22. Centra Wellness Network DEVELOPING CULTURAL COMPETENCE  Policies and contracts that promote cultural accommodations.  Accessible buildings  CC Training  Seeks consumer input  Building relationships with ethnic community groups

23. SUGGESTIONS FOR YOU AS AN INDIVIDUAL  Be aware of your own cultural values and assumptions.  Avoid stereotypes, get to know the individual and each persons view of health care.  Be aware and accepting of differences between cultural groups.  Be aware of intra-ethnic variations within a cultural group.  Seek ways to the develop cultural knowledge.

24. SUGGESTIONS FOR YOU AS AN INDIVIDUAL  Be aware of cultural factors that may affect health care.  Develop the ability and skills to adapt practices to the cultural context of client, family, community.  Apologize when you have offended.  Promote cultural competencies with your words and behavior.

25. THE PLATINUM RULE  “TREAT OTHERS AS THEY WANT TO BE TREATED.”