1. VISIONS, Inc. www.visions-inc.org Main Office: P.O. Box 190797, Roxbury, MA 02119 (p) 617-541-4100 (f) 617-541-4141 Regional Offices: 717 W. End Street, Rocky Mount, NC 27803 (p) 252-442-4022 30547 Seminole Rd., Fresno, CA 93667 (p) 559-549-4915 Enhancing Cultural Competence in Clinical Settings (4C)

2. © VISIONS, Inc. 2011 2 Types of Oppression VariableHistorically Included Groups Historically Excluded Groups RacismRace/Color/EthnicityWhitePeople of Color (African, Asian, Native, Latino/a Americans) SexismGenderMenWomen/Transgender ClassismSocio-Economic ClassMiddle, Upper ClassPoor, Working Class Elitism Education Level Place in Hierarchy Formally Educated Managers, Exempt, Faculty Informally Educated Clerical, Non-Exempt, Students Religious Oppression Anti-Semitism Militarism Religion Military Status Christians, Protestants Christians WW I&II, Korean, Gulf War Veterans Muslims/Catholics, and Others Jew Vietnam Veterans Ageism Adultism Age Young Adults Adults Elders Children/Youth HeterosexismSexual OrientationHeterosexualsGay, Lesbian, Bisexual AbleismPhysical or Mental AbilityTemporarily Able-BodiedPhysically or Mentally Challenged Xenophobia Linquistic Oppression Immigrant Status Language US Born English Immigrant English as a Second Language Non-English A Working Conceptualization of Historically Excluded (Target) and Historically Included (Non-Target) Groups

3. Target / Non-Target Groups- Family Ism/Type of Oppression VariableNon-Target Group Target Group

4. Target / Non-Target Groups - Provider Ism/Type of Oppression VariableNon-Target Group Target Group

5. © VISIONS, Inc. 2011 5 © Dr. Gloria Willcox/St.Lukes’ United Methodist Church/ 4444 – 5 th Avenue North/St. Petersburg, FL 33713

6. © VISIONS, Inc. 2011 6 Feelings As Messengers  Sad  Scared  Mad  Joyful  Peaceful  Powerful –There is a loss –I need comfort, space, and/or support to grieve and let go –There is danger –I need protection, support, and/or reassurance –There is a violation –I need to set limits and/or re- establish boundaries or expectations –Keep on! Feeling Families Messages

7. © VISIONS, Inc. 2011 7  Recognize  Understand  Appreciate  Utilize Differences Pluralism Acceptance, appreciation, utilization and celebration of similarities and differences at these levels: Personal Interpersonal Institutional/Systemic Cultural Monoculturalism (“Melting Pot”) Assimilation Exclusion Pluralism (“Salad Bowl/Fruit Salad”) Diversity Inclusion (“Emancipatory Consciousness”) Social/Economic Justice *Designed by: Valerie A. Batts, Ph.D.; John Capitman, Ph.D.; and Joycelyn Landrum-Brown, Ph.D.. Multicultural Process of Change (at all levels) Monoculturalism Rejection of differences and a belief in the superiority of the dominant group at the following levels: Personal Interpersonal Institutional/Systemic Cultural

8.  Values  Beliefs  Feelings  Attitudes  Opinions  Policies  Practices  Rules  Procedures  Systems  Treatment  Relationships  Behaviors  Communications  Worldview  Stories  Climate  Shared Values  Unwritten Rules  Media  Public Opinion  Symbolic/Ritual  Group Dynamics  Norms Levels of Oppression and Change © VISIONS, Inc. 2011 8

9. Focus of Change Strategies Personal: Aim is to change thoughts and feelings; increase awareness & openness to learning. Interpersonal: Aim is to enhance skills, communication patterns; impact behavior and relationships. Institutional: Aim is to identify structural barriers and create policies, practices, programs & processes that support equitable outcomes. Cultural: Aim is to create environments representative of & welcoming to the organization’s diversity; celebrate & utilize differences. © VISIONS, Inc. 2011 9

10. 10 Modern “ISM” and Internalized Oppression Theory Modern “ISM” Behaviors  Dysfunctional rescuing  Blaming the victim  Avoidance of contact  Denial of differences  Denial of the political significance* of differences Internalized Oppression Behaviors  System beating  Blaming the system  Antagonistic avoidance of contact  Denial of cultural differences/heritage  Lack of understanding of the political significance* of oppression *Political significance includes the social, economic, historical, psychological and structural impacts of oppression.

11. © VISIONS, Inc. 2011 11 Alternative Behaviors for Modern “ISM” and Internalized Oppression Behaviors  Functional Helping (instead of Rescuing)  Problem Solving/Responsibility (instead of Blaming)  Make Mutual Contact (instead of Avoiding)  Notice Differences (instead of Denying Differences)  Learn, Ask about, and Notice the Impact (instead of Denying the Impact)  Confrontation/Standing Up (instead of System Beating)  Take Responsibility (instead of Blaming)  Share Information/Make Contact (instead of Antagonistic Avoiding)  Notice and Share Information about one’s own Differences/Culture (instead of Denying cultural heritage)  Notice, Ask, and Share Information about the impact of the “ism” on me and my target group (instead of Denying the Impact) For all behaviors, personal and organizational problem-solving at the personal, interpersonal, institutional, and cultural levels to generate ongoing multicultural structures and processes.

12. © VISIONS, Inc. 2011 12 Definition of Culture Culture is the sum total ways of living, including:  Values  Beliefs  Aesthetic Standards  Linguistic Expression  Patterns of Thinking  Behavioral Norms  Styles of Communication …which a group of people has developed to assure it’s survival in a particular environment (Pusch, 1981). We are socialized through “cultural conditioning” to adopt the ways of thinking of our own group.

13. HOW CULTURE IS LIKE AN ICEBERG Communicating Across Cultures Just as nine-tenths of an iceberg is below the surface of the water, most of culture is outside of conscious awareness and can be termed “deep culture.” architecture * music * dress food * visual art * drama crafts * dance * literature language * celebration Ethics: definitions of obscenity and sin, rules of decency, conception of justice, notions of modesty, ideals governing child raising, attitude toward dependency and social responsibility Aesthetics: conception of beauty, humor, patterns of visual perception Social relationships: nature of friendship, preference for competition/cooperation, physical expression, relationship with animals, patterns of superiority/inferiority, social interaction rate, courtship practices. Roles/status by sex, race, class, occupation, kinship, age, etc. Communication: expression of emotions, facial expressions, body language, conversational patterns in various social contexts, transfer of knowledge Worldview: cosmology, conception of past and future, ordering of time, notions of logic and validity, tempo of work, conception of “self”, notions of adolescence Health: tolerance of physical pain, definition of insanity, theory of disease Necessities: concepts of food, incentives to work, forms of shelter Authority: patterns of group decision making, approaches to problem-solving, who/what conveys power..and much, much MORE!