1. Cultural Competency in Work with Individuals and Families Developed by DATA of Rhode Island Through a special grant from the Rhode Island Department of Human Services September 2006

2. Learning Objectives Participants will be able to: Describe definitions of diversity and cultural competency Describe definitions of diversity and cultural competency Describe demographic trends for the elderly US population Describe demographic trends for the elderly US population Describe the knowledge and attitudes necessary to provide cultural competent services to family caregivers and recipients Describe the knowledge and attitudes necessary to provide cultural competent services to family caregivers and recipients

3. Overview Demographic changes in the US population over age 65 are making a critical impact on both formal and informal caregiving networks The appreciation of diversity in the caregiving experience although not new, is taking center stage in the discussion on cultural competency in the provision of health, mental health and health and human services for caregivers.

4. DefinitionsDIVERSITY:  Refers to differences between groups with distinctive characteristics and social identities based on culture, ethnicity, gender age sexual orientation, religion ability, and class Cultural Competence :  Refers to the process by which individuals and systems respond to people of all cultures, languages, classes, races, ethnic backgrounds, religions and other diversity factors in manner that affirms and values the worth of individuals, families and communities and protects and preserves the dignity of each.

5. What does it mean to be culturally competence “…having the capacity to function effectively as an individual or an organization within the context of the cultural beliefs, practices and needs presented by persons and their communities that you serve.” “…having the capacity to function effectively as an individual or an organization within the context of the cultural beliefs, practices and needs presented by persons and their communities that you serve.” Source: The National Standards for Culturally and Linguistically Appropriate Services in Health Care, adapted from Cross, Basron, Dennis & Issacs, 1989

6. Why is cultural competence important Everyone has a right to care that meets their needsEveryone has a right to care that meets their needs We are serving an increasingly diverse populationWe are serving an increasingly diverse population Health and human service system are not always responsiveHealth and human service system are not always responsive Health inequalities are experienced by many groupsHealth inequalities are experienced by many groups Cultural competence improves service outcomesCultural competence improves service outcomes It’s the lawIt’s the law

7. Institute On Medicine REPORT: UNEQUAL TREATMENT “ “Racial and ethnic minorities tend to receive a lower quality of healthcare than non-minorities, even when access-related factor as such as patient’ insurance status and income are controlled. The sources of these disparities are complex, are rooted in historic and contemporary inequities, and involve many participants at many levels...”

8. Conditions or factors that are important or relevant for you to know? A disproportionately high percentage of minority adults have severe disabilities This is particularly true of African American and Hispanic women A wide range of internal and external cultural factors can influence a persons behavior

9. HIV/AIDS DEATH RATE AGE> 13, RATES PER 100,000 POPULATION

10. CANCER DEATH RATE DEATHS PER 100,000 POPULATION

11. CARDIOVASCULAR DISEASE DEATH RATE DEATHS PER 100,000 POPULATION

12. DIABETES-RELATED DEATH RATE DEATHS PER 100,000 POPULATION

13. Cultural Competency  Two Approaches:  Fact Centered approach emphasizes the importance of acquiring knowledge about the target group in order to increase one’s understanding  Attitude Centered approach has at its core belief an openness to embrace diversity, and recognizes one’s own beliefs, attitudes and behaviors that may parallel or conflict with those of the client’s.

14. Cultural Factors That influence Individuals and Groups Internal Factors Cultural/Racial Identity Socioeconomic Status/Class NationalityLanguage Family Constellation Social History Health Beliefs & Practices Perception of Disability Age & Life Cycle Issues Spatial & Regional Patterns Gender & Sexuality (sex roles) Sexual Orientation Religion & Spiritual Views Political Orientation & Affiliation External Factors Institutional Biases Community Economics Intergroup Relations Natural Networks of Support Community History Political Climate Workforce Diversity Community Demographics Modified from James Mason, Ph.D., NCCC Senior Consultant Developed by National Center for Cultural Competence, 2002

15. Ways to Facilitate Communication Across Cultural Boundaries 1.Recognize differences 2.Build Your Self-Awareness 3.Describe, Identify, carefully Interpret 4.Don’t assume your interpretation is correct 5.Verbalize your own non-verbal signs 6.Share your experience honestly 7.Acknowledge any discomfort, hesitation, or concern 8.Practice politically correct communication 9.Give your time and attention when communicating 10.Don’t evaluate or judge

16. CULTURAL COMPETENT COMMUNICATION SKILL LEARN Model L L istening to the patient’s perspective E E xplaining and sharing one’s own perspective A A cknowledging differences & similarities between these two perspectives R R ecommending a treatment plan N N egotiating a mutually agreed-on treatment plan Berlin EA, Fowkes, WC Jr. West J Med 1983; 139(6):934-8

17. Practical ways to enhance cultural competence Understandable and Respectful Care of persons served Employ Diverse Staff and Leadership Ongoing Education and Training for all staff Language Assistance Services Right to Receive Language Assistance Services Competence of language Assistance Patient- Related materials in other languages Written program Plans that incorporate cultural issues Patient/Consumer Data/demographic and satisfaction Community Partnerships Conflict /Grievance Processes

18. DEMOGRAPHICS  35 million persons in the US over age 65 12% of the population, baby boomers are projected to push that up to 34%.  Racial and ethnic minorities represent 16.4% of that population, progressing to 25.4% by 2030.  3.4 million of the elderly are below the poverty level, another 2.2 million are classified as near poor (125% of the poverty level)  8.9% of elderly whites are poor, compared to 22.3 % of elderly African Americans and 18.8% of elderly Latinos.  The highest poverty rates were among older Latina women who lived alone or with non relatives

19. Questions Wrap up