CULTURAL COMPETENCE: An Essential Ingredient for Quality, Access & Elimination of Disparities

1. CULTURAL COMPETENCE:AnEssentialIngredient forQuality, Access &Elimination of Disparities

2. Mission To increase access to comprehensive primary and preventive health care and to improve the health status of underserved and unisured populations who experience financial, geographic, cultural, or linguistic barriers to care. Accomplishes by Providing services to 10.35 million uninsured and underserved persons Supporting 700 grantees with more than 4000 service sites Bureau of Primary Health Care: http://www.bphc.hrsa.gov

3. Department of Health and Human Services

4. Consolidated Health Center Programs“Programs are Owned by the Communities” • Community Health Centers • Migrant Health Centers • Health Care for the Homeless • Public Housing Primary Care • School Health (Healthy Schools, Healthy Communities)

5. Health Center Patients:By Race/Ethnicity - 1997 Source: BPHC UDS

6. Health Center Patients (8.3M):By Age, Gender - 1997 Thousands of Patients Source: BPHC UDS

7. Health Center Patients:By Economic Status - 1997 Source: BPHC UDS

8. Campaign for 100% Access andZero Health Disparities • Never be able to meet the needs of every community with Federal resources alone • Strengthen and expand network of primary care • Develop nation-wide, state-based, community-driven partnerships with organizations that share vision and can serve as resource for communities • Build community partnerships

9. Cultural Competence: Relationship to Campaign: • 100% Access & Zero Disparities… It cannot be done without cultural competence • Campaign needs community partnerships • Partnerships cannot work without C.C. • Assumption... Cultural Competence is the nexus of 100% -- Zero Campaign

10. WHY CULTURALLY COMPETENT HEALTH CARE? • Improve Quality of Services and Outcomes • Respond to Consumer Needs/Marketing • Meet Accreditation/Contract/Regulatory Requirements • Reduce Liability/Malpractice • Support Student/Workforce Diversity Initiatives • Deal with Personal Experiences • Achieve Social Justice Robert C. Like, MD, MS, Center for Healthy Families and Cultural Diversity, Department of Family Medicine, UMDNJ-Robert Wood Johnson Medical School

11. Why is Cultural Competence So Vital at HRSA/BPHC? • Increased Access and Reduced Disparities are directly linked to cultural competence. • The people we serve are ethnically and culturally diverse. • Health outcomes will be eventually linked to cultural competence. • Sound Business Practice

12. THE CHANGING U.S. POPULATION • By the Year 2000, 39% of the U.S. population will be foreign born or children of foreign-born • A century from now, 50% of all Americans will be Black, Hispanic, or Asian in origin

13. CHILDREN’S DEFENSE FUND PREDICTIONS • 5.5 million more Hispanic children • 2.6 million more African-American children • 1.5 million more children of other races • 6.2 million fewer white, non-Hispanic children BY THE YEAR 2030 From Hanson MJ: “Ethnic, Cultural, and Language Diversity in Intervention Settings,” in Developing Cross-Cultural Competence: A Guide for Working with Young Children and Their Families, eds, EW Lynch, MJ Hanson, Baltimore MD: Paul H. Brookes Publishing Company, 1992, p.7.

14. LINGUISTICALLY COMPETENT HEALTHCARE Language Access Responsibilities • Federal Law • State Law • Private Sector

15. Title VI of the Civil Rights Act “No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.” SEE: OFFICE OF CIVIL RIGHTS GUIDELINES

16. Patterns in Cause of Death by Minority Group, 1992 AIAN AAPI Black Hispanic  Cancer  Not known due to aggregated & missing data Cardiovascular Disease    Chemical Dependency    Diabetes   Infant Mortality Violence     = higher Homicide death rate than for whites  Suicide    Un - Injury   AIDS/HIV Source: National Center for Health Statistics, 1994. From: Nickens HW: ”The Role of Race/Ethnicity and Social Class in Minority Health Status,” Health Services Research, 30 (1):156, 1995.

17. Elements of Cultural Competence I Organizational/Systemic/Socioeconomic • Attitudes • Skills • Behaviors • Policies • Acquire Knowledge • Apply Health Info • Beliefs/Attitudes • Practices • Communications Cross, et al., 1989-90

18. Elements of Cultural Competence II Epidemiological/Outcome • Prevalence • Across Cultural Populations • Treatment Efficacy • Outcomes • Across Cultural Populations Lavizzo-Mourey/Mackenzie, 1995

19. 7 Cultural Competence Domains • Values & Attitudes • Communication Styles • Community/Consumer Participation • Physical Environment, Materials & Resources • Policies & Procedures • Population-Based Clinical Practice • Training & Professional Development From: Goode,1997 & Sue, 1998

20. CULTURALLY COMPETENT CONTINUOUS QUALITY IMPROVEMENT

21. CULTURALLY COMPETENT CONTINUOUS QUALITY IMPROVEMENT • Patient Self-Management • Community-Based Systems • Decision Support • Delivery System Design • Clinical Information Systems • Leadership

22. BENEFITS OF CULTURAL COMPETENCE IN HEALTH CARE Improved Health Outcomes Maximal Use of Limited Resources Increased Customer Retention and Access to Care Increased Customer Recruitment Increased Customer Satisfaction Provide Products/Services Consistent with Client Needs Culturally Competent Management, Staff, & Practitioners (Adapted from American Association of Health Plans, Minority Management Program, 1997)

23. A Sampling of Cultural Competency Activities at BPHC • Bureau of Primary Health Care • 100% Access - Zero Disparities Campaign • National Center for Cultural Competence • http://www,dml.georgetown.edu/depts/pediatrics/gucdc/cultural.html • Identification of Promising Practices • Cultural Competence Monograph Series • http://www.hrsa.gov

24. Cultural & Linguistic Competence: What Works? (I) • Formal, Implemented Policies • Staff Recruitment & Hiring • Staff Training • Self Assessment • Adaptation to Demographic Shifts • Translation, Interpretation & Signage • Connecting Culture to Quality, Access & Elimination of Disparities (Performance)

25. Cultural & Linguistic Competence: What Works? (II) • A Culture Friendly Environment • Staff • Milieu • Language • Respecting Traditional Beliefs/Practices • Integrating the Community in Healing Process • Valuing Diversity

26. Cultural Competence is a Long Journey with measurable milestones along the way...

27. OUR JOURNEY HAS ONLY BEGUN!