1. Cultural Competency Improving Care Creating Change

2. Influence of Culture Definition first~ Historical: Culture is social heritage, or tradition that is passed on to future generations. Behavioral: Culture is shared, learned human behavior, a way of life. Normative: Culture is ideals, values, or rules for living

3. Influence of Culture Functional: Culture is the way humans solve problems of adapting to the environment or living together. Mental: Culture is a complex of ideas, or learned habits. Structural: Culture consists of patterned and interrelated ideas, symbols, or behaviors. Symbolic: Culture is based on arbitrary assigned meanings that are shared by a society

4. Aspects of Culture in Human Behavior This is what we see first, that is after we get past the dress and food! This information is shared among the group. You may not always know the “whys” of your observations. This behavior has sustained generations!

5. Our cross-cultural experiences At first contact: We may recognize the extreme contrasts We may have emotional reactions We may be perplexed by some behaviors We may make negative attributions We may become entrenched in our own values

6. Theoretical Concept for Understanding Culture The value of a theory is to explain and predict. Theories abound Individualism and Collectivism

7. Individualism v. Collectivism Autonomy Competition Independent self Ego-focused Confrontation OK Dependence avoiding Success via self In/out group fluid In group harmony Cooperation Interdependent self Shared emotions (shame) Confrontation not OK Group achievement In/out group boundary strong

8. Culture and Health Complex concepts do not have exactly the same meaning in all cultures. US: “Good Health” may include absence of harmful bacteria and/or chemical imbalances. China: “Good Health” may involve Yin and Yang and health is achieved when harmony present.

9. Culture Specific Concepts People learn to express their symptoms of distress in ways acceptable to others in their culture.

10. Culture General Concepts These may include subjective feelings of well-being, adequate energy to perform tasks, appropriate sexual activity and/or expressions of support from others.

11. Developing cultural sensitivity in health care delivery systems Modifying behavior so that recommendations are placed into a framework familiar to the patient, and have an opportunity to be successful. This is demonstrating cultural sensitivity.

12. Achieving Practical Cultural Competency Key cultural values that affect care: Status Privacy Fatalism Emphasis on Individual or Group Access to Information

13. Cultural Competency in Organizations Cultural destructiveness Cultural Incapacity Cultural Blindness Cultural Pre-competence Basic Cultural Competence Advanced Cultural Competence

14. Cultural Destructiveness Examples within an organized system: Practice of cultural genocide, sub- humanizing patients of color. (Tuskegee Experiment) Denying clients access to their natural healers. Medical experiments without their knowledge or consent

15. Cultural Incapacity Not intentionally destructive, but lacks capacity to help diverse clients. May take a “paternal” posture toward “lesser” races. Disproportionately applies resources. Enforces racist policies or maintains stereotypes. Gives subtle “not welcome” messages.

16. Cultural Blindness While expressing a philosophy of being unbiased, believes that color or culture makes no difference. believes that the helping approaches by dominant culture are universally acceptable and applicable. ignores cultural strengths, encourages assimilation.

17. Cultural Pre-Competence Realizes weakness in serving diverse population and makes attempts at specific improvements. Explores ways to reach clients. May feel a false sense of accomplishment that prevents further movement. May engage in tokenism.

18. Basic Cultural Competence Has acceptance and respect for differences. Engages in continuing self- assessment regarding cultural understanding. Makes adaptations to service models in order to meet client needs. Seeks advice and consultation from client community.

19. Advanced Cultural Competence Holds culture in high esteem Adds to the knowledge base by continuing research, developing new approaches based on culture. Hires staff who are specialists in culturally competent practice. Advocates for systemic cultural competence.

20. Competencies and Resources Understanding culture-general ideas Understanding culture-specific ideas Resources for further growth