What is Culture and Cultural Competence?

1. What is Culture and Cultural Competence? Cecily Rodriguez Director, Office of Cultural and Linguistic Competence DBHDS

2. Today’s Outcomes: • Give a rationale for this work • Explore the cultures with which we are affiliated • Define “Cultural Competency” • Look at some strategies to deepen your ability to provide culturally and linguistically appropriate services.

3. Rationale for Cultural Competency Why We Can’t Wait!

4. Why Cultural Competence? • Growing Population diversity • Disparities in access and outcomes • Limited staff with CLC expertise • Lack of organizational and systemic focus on CLC Efforts • Legal requirements related to language access • Federal and state expectations and accreditation criteria

5. What is culture? DBHDS defines culture in the broad sense, as there are other things in addition to race, language, and ethnicity that contribute to a person’s sense of self in relation to others. Multiple memberships in these subgroups contribute to an individual’s personal identity and sense of own “culture”.

6. How is culture like an iceberg? Model from the National Center for Cultural Competence • Visible Part: • Ways of life • Laws and customs • Institutions • Rituals • Language • Hidden Part: • Norms • Roles • Ideologies • Beliefs • Philosophy • Values • Tastes • Attitudes • Assumptions • Expectations • Myths

7. Dimensions of Culture

8. REMEMBER! • Using generalizations to understand a group of people is productive and helps one gain insight into communication styles and behaviors • Using stereotypes to categorize or judge people is destructive and discriminatory.

9. The Traditional Culture of the Health and Human Services System • Emphasis on diagnosis and disability labels • Focus on interventions, goal setting, and data collection • Terminology, acronyms and jargon • Focus on professionals determining what is best for the individual and how to satisfy rules and regulations.

10. Traditional American Macro Culture American culture has at its roots: • Belief in the value of equality, self determination, self-reliance, and independence • Preference for informality and direct communication • Focus on clock time and calendars, meeting deadlines and punctuality • Faith in technology and sciences

11. Micro Cultures • Is a small unit of culture within a wider general culture. It is the identity and traits of a particular people within a dominant culture that is never lost to assimilation. • It is the customary beliefs, social forms and material traits of a racial, religious or social group. • There are many micro cultures living in the US • Immigrant communities • Minority communities • Religious communities • Ideological communities • Most people in micro cultures have to straddle their own culture and that of the macro culture to navigate daily life.

12. American Macro Culture Sees disability caused by medical problems or physical trauma during pregnancy Assumes it is best to “do something” about the disability. The focus in on improving the situation Response to disability is to provide treatment and research. Micro/Immigrant Culture Sees disability as caused by a spiritual crisis (blessing or punishment). May blame some action like a “susto” May take a “wait and see” approach. They may feel that the disability is there for a purpose and should not try to cure it. May respond through prayer, talisman, rebalancing of the body (through food or drink). Use acupuncture or ceremonies to deal with or heal the disability. Examples of differences in macro and micro/immigrant cultures related to disabilities

13. WHAT IS CULTURAL COMPETENCE? There are five abilities that are considered necessary to achieve individual cultural competence. • We value diversity • We are able to understand our own cultural views (and those of our affiliated organizations and systems) • We are aware of how culture may be affecting a life situation • We are willing and able to learn about other cultures • We are able to change our behavior to meet the needs of others and other cultures.

14. Strategies to improve cultural competence

15. National Standards on Culturally and Linguistically Appropriate Services (CLAS) • Organized by themes: • Culturally Competent Care (Standards 1-3) • Language Access Services (Standards 4-7) • Organizational Supports for Cultural Competence (Standards 8-14)

16. Definition of Cultural Competence

17. CLAS 1-3 Standards for Culturally Competent Care

18. CLAS 1-3 • Take the time to recruit & retain diverse and culturally competent employees… • Participate in networks for diversity recruiting • Post in diverse papers and/or websites • Make accommodations for language and technology barriers for applicants • Host internal “support” groups for new hires

19. CLAS 1-3 • DON’T FORGET ADMINISTRATIVE STAFF!! • We spend a lot of time training health care and other professionals to provide culturally and linguistically competent services and supports. • BUT! families have to make appointments, ask questions about insurance, check in, and provide information at each visit.

20. CLAS 1-3 • Minimal training activities for all staff: • Cross cultural communication • Communicating complex information to individuals who possess low literacy skills or who are not literate or not verbal. • confronting bias, discrimination, and racism in health, mental health, and social service systems.

21. CLAS 4-7 Language Access Services

22. Definition of Linguistic Competence The capacity of an organization and its personnel to communicate effectively, and convey information in a manner that is easily understood by diverse audiences including persons of limited English proficiency, those who have low literacy skills or are not literate, and individuals with disabilities.

23. Language Access Services • Ensure that interpreting and translating services are considered mission critical. • Budget for those costs as you would any overhead and consider them the cost of doing business, not just a luxury. • Request/require all bi-lingual staff to become certified interpreters and pay them for that additional skill when the perform it. • Train ALL staff to work effectively with interpreters

24. CLAS 4-7

25. Literacy • The NAAL (National Assessment of Adult Literacy) administered tests which revealed that an estimated 14% of US residents would have extreme difficulty with reading and written comprehension • Fourteen percent of adults (30 million people) have Below Basic health literacy. 

26. CLAS 8-14 Organizational Supports for Cultural Competence

27. CLAS 8-14

28. CLAS 8-14

29. What’s Next? • The most important thing you can do to become more culturally competent is to understand your own culture and assess your bias and the lens with which you view your world. • Take the online tests to deepen your self-awareness. • https://implicit.harvard.edu/implicit/demo/ • http://erc.msh.org/mainpage.cfm?file=3.0.htm&module=provider language=English • Take some time to learn about the culture and languages of the communities in your service area.

31. For More Information http://www.dbhds.virginia.gov/OHRDMCLC.htm Cecily Rodriguez Cecily.rodriguez@dbhds.virginia.gov 804.786.5872