1. Health Systems – Access to Care and Cultural Competency Tonetta Y. Scott, DrPH, MPH Florida Department of Health Office of Minority Health

2. 2 Objectives Define culture. Define and discuss culturally and linguistically appropriate services. Understand how culturally competent healthcare systems affect access to care. Understand the principles of culturally competent health systems as it relates to HIV/AIDS services.

3. 3 The demographics of Florida are changing… U.S. Census Bureau, 2012

4. 4 Access to Care Health insurance Delayed or sacrificed care Communication Preventive care Families’ financial well-being Societal effects

5. 5 Culture The integrated pattern of thoughts, communications, actions, customs, beliefs, values, and institutions associated, wholly or partially, with racial, ethnic, or linguistic groups, as well as with religious, spiritual, biological, geographical, or sociological characteristics. Culture is dynamic in nature, and individuals may identify with multiple cultures over the course of their lifetime. Think Cultural Health, 2013

6. 6 What do you see?

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9. 9 Cultural and Linguistic Competence A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations. Cultural Competency Cultural Sensitivity Cultural Awareness Cultural Knowledge

10. 10 Stages of Cultural Competency Cultural Knowledge Familiarization with selected cultural characteristics, history, values, belief systems, and behaviors of the members of another ethnic or cultural group. Cultural Awareness Developing sensitivity and understanding of another ethnic or cultural group. Involves internal changes in terms of attitudes and values. Cultural Sensitivity Knowing that cultural differences as well as similarities exist, without assigning values to those cultural differences.

11. 11 Levels of Cultural Competency Destructiveness Incapacity Blindness Pre-competence Competence Proficiency

12. 12 National CLAS Standards Intended to advance health equity, improve quality, and help eliminate health care disparities by providing a blueprint for individuals and health and health care organizations to implement culturally and linguistically appropriate services. Adoption of these Standards will help advance better health and health care. Think Cultural Health, 2013

13. 13 Health Care Systems A well functioning health system responds in a balanced way to a population’s needs and expectations by: Improving the health status of individuals, families, and communities. Defending the population against what threatens its health. Protecting people against the financial consequences of ill-health. Providing equitable access to people-centered care. World Health Organization, 2010

14. 14 Culturally Competent Healthcare A culturally diverse staff that reflects the community(ies) served. Providers or translators who speak the clients’ language(s). Training for providers about the culture and language of the people they serve. Signage and instructional literature in the clients’ language(s) and consistent with their cultural norms. Culturally specific healthcare settings. Anderson et al., 2003

15. 15 Cultural Competency and HIV/AIDS National Minority AIDS Education and Training Center (NMAETC) BE SAFE – A Cultural Competency Model African Americans American Indians, Alaska Natives, and Native Hawaiians Asians and Pacific Islanders Latinos

16. 16 BE SAFE Barriers to Care Ethics Sensitivity of the Provider Assessment Facts Encounters

17. 17 Becoming Culturally Competent Addressing overt and covert barriers to care. Assessing their level of awareness and sensitivity toward culturally diverse patients with HIV/AIDS. Conducting a cultural assessment. Obtaining knowledge about this cultural group. Maintaining effective clinical encounters.

18. 18 Cultural Competency Strategies 1. Provide interpreter services. 2. Recruit and retain minority staff. 3. Provide training to increase cultural awareness, knowledge, and skills. 4. Coordinate with traditional healers. 5. Use community health workers. Center on an Aging Society, 2004

19. 19 Cultural Competency Strategies 6. Incorporate culture-specific attitudes and values in health promotion tools. 7. Include family and community members in health care decision making. 8. Locate clinics in geographic areas that are easily accessible for certain populations. 9. Expand hours of operation. 10. Provide linguistic competency that extends beyond the clinical encounter to the appointment desk, advice lines, medical billing, and other written materials. Center on an Aging Society, 2004

20. 20 Outcomes of Health Systems Providing CLAS Decrease in miscommunication Increased provider sensitivity to their own beliefs and behaviors Increased ability of providers to understand and treat a culturally diverse clientele with varied health beliefs and practices

21. 21 Outcomes of Health Systems Providing CLAS Increased trust and confidence of clients in accessing health care. Increased client satisfaction. Increased access to quality health care services by diverse populations Increased adherence to treatment and recommendations

22. 22 Conclusions Providing culturally competent services has the potential to: Improve health outcomes. Increase the efficiency of staff. Result in greater client satisfaction with services.

23. 23 Take Home Points Strengthening of health systems through cultural and linguistic competence is a necessary prerequisite for improving the prevention of HIV infection and the care of HIV-infected persons. Cultural competence is a journey – not a destination. A process of becoming competent, not being culturally competent.

24. 24 Contact Information Tonetta Y. Scott, DrPH, MPH State Partnership Grant Program Manager Tonetta_Scott@doh.state.fl.us www.doh.state.fl.us/minority/SPG StatePartnershipGrant@doh.state.fl.us 850-245-4941