Developing Cultural Competence

An Introductory Look at Cultural

Competency in Health Care

Presented byTom Rue, M.A., CASAC, CCMHC – AC II

Richard C. Ward Addiction Treatment CenterAt Core Training – March 2008

“Cultural competence…a journey, not a destination”

Objectives

• Increase awareness of cultural competence

• Understand the elements of cultural competence in health care

• Apply cultural competence mindset to your job/responsibilities

. . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cultural Norms

“Should’s and ought’s of the group. Examples are standards of behavior such as:

- productivity norms

- equity norms

- styles of dress

- power and control in relationships

- acceptable behaviors, etc.

What is Culture?

Culture is the acquired knowledge that Culture is the acquired knowledge that people use to interpret experience and people use to interpret experience and generate social behavior.generate social behavior.

Cultural Value OrientationsCultural Value Orientations

• Innate Human Nature

• Relationship to Nature

• Relationship to Time

• Purpose of Being

• Relationship to Other Persons

What is Cultural Diversity?

• Culture is shared . . .– Values, norms, traditions/customs– Arts– History, folklore– Institutions

• Cultural Diversity– Differences in race, ethnicity, language,

nationality, religion, other beliefs

Cultural Components

• Race

• Country of origin

• Native language

• Socio-economic status

• Education level

• Religion

• Mental or physical abilities

More Cultural Components• Heritage• Acculturation• Age• Gender• Sexual orientation• Definition of normality

– Such as “mental illness”

• Responses to abnormality– Stigma vs. Acceptance

Functional Definition

Use of knowledge about individuals and groups of people to produce

• policies

• practices

• attitudes

• specific standards

• Awareness and acceptance of cultural differences • Self Awareness• Understanding of dynamic differences among cultures• Basic knowledge about a client’s culture• Adaptation

Components of Cultural Competence

Cultural Competence in Health Care• Set of attitudes, skills, behaviors, policies

– Enables organizations and individuals to work effectively cross-culturally

– Understands importance of health-related• beliefs, attitudes, and practices

• communication patterns of beneficiaries

– Eliminates disparities in health status

Cultural Competence in Health Care

• A demonstrated awareness and integration of three population specific issues– health-related beliefs and cultural values– disease incidence and prevalence

• examples: gender, Native Americans, Irish, etc.

– treatment efficacy

Cultural Competence in Health Care

• Responds to demographic changes in US• Improves quality

– services

– health outcomes

• Meets mandates of credentialing bodies: – Commission on Accreditation of Rehabilitation

Facilities (CARF)

– Joint Commission on Accreditation of Hospital Organizations (JCAHO)

– US Department of HHS, Office of Minority Health

National Standards for Culturally and Linguistically Appropriate Services in

Health Care (CLAS)

National Standards for Culturally and Linguistically Appropriate Services in

Health Care (CLAS)• Main Themes

– Culturally competent standards (1-3)– Language access services (4-7)– Organizational support (8-14)

• Varying Stringency– Mandates (4,5,6, & 7)– Guidelines 1,2,3,8,9,10,11,12,13)– Recommendations (14)

Full document is on the website of U.S. Department of Health & Human Services, Office of Minority Health at http://www.omhrc.gov/clas/finalcultural1a.htm.

Why?

Demographic Statistics

• 67 million (1 in 4) classified as minority• Latinos

– Represent almost half of minority Americans

– Nearly equal in number to African Americans

– Largest racial/ethnic minority population by 2025

• People of color– 1 in 3 Americans by 2050

• Higher birth rates

• Higher immigration rates

Percent Distribution of US Population by Race and Ethnicity

1999

71%

12%

4%

12%

1%White, non-Latino

African American

Asian/Pacif ic Islander

Latino

American Indian/ AlaskanNative

Health Care Statistics• Mortality rates higher until age 44

– African Americans– Latinos– Native Americans

• Infant mortality– Twice as high among African Americans

• Deaths due to HIV/AIDS– Dramatically increased

• African Americans• Latinos

Mortality Rates by Gender for Americans with Incomes Under

$9,000, Ages 25-64, 1991

19.5

7.6

16

6.5

0

5

10

15

20

25

Males Females

AfricanAmerican

White, non-Latino

Mortality Rates by Race and Gender for Americans with Incomes Over

$25,000, Ages 25-64, 1991

3.6 2.32.4 1.6

-5

5

15

25

Males Females

AfricanAmerican

White, non-Latino

Individual Cultural Competence Continuum Model

Organizational Cultural CompetenceA journey, not a destination...

Unaware, Competent

Aware, Incompetent

Aware, Competent

Unaware, Incompetent

Journeying to a Culturally Competent Organization

•Communication is encouraged

•Staff represent the diversity of community members

•Leadership is committed and supportive

•All employees are involved

•Inclusive organizational structures and policies exist

Our Journey

• Sharing experiences

• Progressing along our personal continuum

• Moving closer to our destination

AND always . . .

Improving the quality of health care in the communities we serve

Charlotte Newman & Jan Kelley (2001). Cultural Quality: An Introductory Look into Cultural Competency in Health Care, slide show for the Delmarva Foundation

Hope Center for Advance Technologies (2001). Psychology With Sociology, a course developed by faculty from Lawrence Technological University, University of Detroit-Mercy, and Wayne State University

Joan Engebretson (2001). Culture and Health Care, class notes for Advance Practice Nursing: Health Promotion, The University of Texas-Houston, Health Science Center School of Nursing

Acknowledgements