achieving cultural and linguistic …...slide source: national center for cultural competence, 2011...

Tawara D. GoodeMarch 22, 2011

ACHIEVING CULTURAL AND LINGUISTIC COMPETENCE: Implications for Systems Supporting the Health and

Mental Health of Young Children and their Families

National Center

for Cultural

Competence

WEBINAR OBJECTIVES

This webinar will: (a) delineate the multiple dimensions of culture within the contexts of young children, their families, and systems that provide them with services and supports; (b) describe conceptual frameworks for advancing and sustaining cultural and linguistic competence; and (c) examine system and organizational roles in addressing health and mental health equity.

Slide Source: © 2011 - National Center for Cultural Competence

Exploring the Multiple Dimensions of Culture

How do we develop a system of care for young children and their caregivers that is better at engaging multiple cultures of both parents and providers?

Are there specific gaps we should be looking more closely at that would indicate where we are successful and where we are falling short?

Sonni Verling, Iowa Department of Public Health

Slide Source:© 2011 - National Center for Cultural Competence

Culture is the learned and shared knowledge that specific groups use to generate their behavior and interpret their experience of the world. It includes but is not limited to:

thought

languages

values

beliefs

customs

practices

courtesies

rituals

communication

roles

relationships

expected

behaviors

Culture applies to racial, ethnic, religious, political, professional, and other social groups. It is transmitted through social and institutional traditions and norms to

succeeding generations. Culture is a paradox, while many aspects remain the same It is also dynamic , constantly changing.

manners of

interacting

Slide Source:© 2011 - National Center for Cultural CompetenceData Source: Gilbert, J. Goode, T., & Dunne, C., 2007.

Culture …is applicable to all peoples

is active & dynamic

is multi-layered

is viewed as thick, thin, or compartmentalized

exists at conscious and unconscious levels

structures perceptions & shapes behaviors

is a total way of life –tells group members how to behave& provides their identity

Adapted from Vivian Jackson, NCCC, 2003Slide Source:© 2011 - National Center for Cultural Competence

CultureCulture is akin to being the personobserved through a one-way mirror; everything we see is from our ownperspective.

It is only when we join the observed on the other side that it is possible to see ourselves and others clearly – but getting to the other side of the glass presents many challenges.

(Lynch & Hanson 1992 Developing Cross Cultural Competence)

Slide Source: 2011 - National Center for Cultural Competence

CULTURE IS THE LENS BY WHICH WE VIEW THE WORLD


Cultural Diversity

Goode & Jackson, 2009

The term cultural diversity is used to describe differences in ethnic or racial classification & self-identification, tribal or clan affiliation, nationality, language, age, gender, sexual orientation, gender identity or expression, socioeconomic status, education, religion, spirituality, physical and intellectual abilities, personal appearance, and other factors that distinguish one group or individual from another.


Cultural Factors That Influence Diversity Among Individuals and Groups

Adapted with permission from James Mason, Ph.D., NCCC Senior Consultant

Cultural/Racial/Ethnic IdentityTribal Affiliation/ClanNationalityAcculturation/AssimilationSocioeconomic Status/ClassEducationLanguageLiteracyFamily ConstellationSocial HistoryPerception of TimeHealth Beliefs & PracticesLiteracy

Internal Factors

Health & Mental Health LiteracyBeliefs about Disability or Mental Health Lived Experience of Disability or Mental Illness Age & Life Cycle IssuesGender, Gender Identity & Expression Sexual OrientationReligion & Spiritual ViewsSpatial & Regional Patterns Political Orientation/Affiliation


Cultural Factors That Influence Diversity Among Individuals and Groups

Institutional BiasesRacism & DiscriminationCommunity EconomicsIntergroup RelationsGroup & Community Resiliency

External Factors

Natural Networks of SupportCommunity HistoryPolitical ClimateWorkforce DiversityCommunity Demographics

Slide Source:© 2011 - National Center for Cultural CompetenceAdapted with permission from James Mason, Ph.D., NCCC Senior Consultant

Examining Cultural Beliefs and Practices in Health and Mental Health

Superstition Fate or Destiny Karma Malevolent Forces Religiosity & SpiritualityCultural & Familial Folklore


Cultural Beliefs about Health, Mental Health, & Disability

Reliance on traditional remedies and healers Culture bound syndromes

Delaying access to careHistorical mistrust of health care, mental health,and social service professionals

Experiences of racism, discrimination, and bias

Cultural and linguistic barriers

Stigma

Cultural Influences on Beliefs and Practices Related to Systems and Providers of

Health and Mental Health Care

T.D. Goode


CHILD

A Convergence of Cultural Contexts

NCCC-GUCCHD, 2006.

T.D. Goode

Family Early

Care &

Education

Systems

Health

Care

System

Mental

Health

Care

System

Religious &

Spiritual

Community

Socio-economic

Political

Environment

Community

Legal System

Early

Intervention

System

Social Services

System

Educational

& Vocational

Systems


T.D. Goode


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Cultural CompetenceDefinition & Framework

What is an easy-to-articulate response to: What is Cultural Competency and is it the same as Cultural Sensitivity/Awareness?

Cindy Bernal, Pueblo Community College, Colorado


Are we on the same page?Culturally

aware

Cultural sensitivity

Culturally appropriate

Culturally effective

Culturally

relevant

Culturally competent

Cultural humility

Culturally & linguistically competent

Linguistically competent Cultural

Proficiency

Multicultural Competence

T.D. Goode Slide Source:© 2011 - National Center for Cultural Competence

Cultural ResponsivenessCulturally relevant

What are specific areas in which cultural competence can be formalized and integrated into early childhood service delivery systems in a meaningful way?

Currently many systems include the words “cultural competency” in professional development requirements or to describe programs or materials; however, there is no deeper or more meaningful guidance provided.

Cultural competence is sometimes thought of as an add-on component to services instead of an integral part of them. How can cultural competence become more than an afterthought?

Reyna Hernandez, Latino Policy Forum, Illinois


Cultural Competence

behaviors

attitudes

policies

structures

practices

requires that organizations have a clearly defined, congruent set of values and principles, and demonstrate behaviors, attitudes, policies, structures, and practices that enable them to work effectively cross-culturally

(adapted from from Cross, Bazron, Dennis and Isaacs, 1989)


Five Elements of Cultural Competence

Organizational Level

value diversityconduct cultural self-assessmentmanage the dynamics of differenceinstitutionalize cultural knowledgeadapt to diversity

- policies - structures- values - services

(Cross, Bazron, Dennis and Isaacs, 1989)


Five Elements of Cultural Competence

Individual Level

(Cross, Bazron, Dennis and Isaacs, 1989)

acknowledge cultural differencesunderstand your own cultureengage in self-assessment acquire cultural knowledge & skillsview behavior within a cultural context


ESSENTIAL ELEMENTS IN ACULTURALLY COMPETENT SYSTEM

These five elements must be manifested at every level of an organization including:

! policy makers! administration! practice & service delivery ! patient/family/consumer ! community

and reflected in its attitudes, structures, policies, practices, and services.

Adapted from Cross, Bazron, Dennis, & Isaacs, 1989


Cultural Destructiveness

CulturalIncapacity

Cultural Blindness

CulturalPre-Competence

CulturalCompetence

CulturalProficiency

Cultural Competence Continuum(Cross, Bazron, Dennis and Isaacs, 1989)



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Linguistic CompetenceDefinition & Framework

Slide Source: National Center for Cultural Competence, 2011Data Source: U.S. Census Bureau 2009 American Community Survey – 1 Year Estimates

Linguistic isolation refers to households in which no person over the age of 14 speaks English at least very well

Linguistically Isolated Households in the U.S. in 2009

What is Linguistic Isolation?

All households 4.7%Households speaking--! Spanish 25.9%! Other Indo-European languages 16.6%! Asian and Pacific Island languages 27.5%! Other languages 17.2%

is the capacity of an organization and its personnel to communicate effectively, and convey information in a manner that is easily understood by diverse groups including persons of limited English proficiency, those who are not literate or have low literacy skills, individuals with disabilities, or those who are deaf or hard of hearing

requires organizational and provider capacity to respond effectively to the health literacy needs of populations served

ensures policy, structures, practices, procedures and dedicated resources to support this capacity

Linguistic Competence

Goode & Jones, Revised 2009, National Center for Cultural Competence


Slide Source: National Center for Cultural Competence, 2011

Linguistic Competence: Legal Mandates, Regulations, Guidance, and Standards

Title VI, Section 601, Civil Rights Act of 1964Non- Discrimination based on Race, Color, National Origin, Age, Disability, Sex

U.S. Department of Justice

U.S. Department of Education

U.S. Department of Health & Human Services

Linguistic Competence: Legal Mandates, Regulations, Guidance, and Standards


Title VI of the Civil Rights Act of 1964,Section 601 Non-Discrimination inFederally-Assisted Programs

National Standards on Culturally and Linguistically Appropriate Services

(CLAS)

Who is covered under the guidance?

Recipients of HHS assistance may include, for example:• Hospitals, nursing homes, home health agencies, and managed

care organizations. • Universities and other entities with health or social service

research programs. • State, county, and local health agencies. • State Medicaid agencies. • State, county and local welfare agencies. • Programs for families, youth, and children. • Head Start programs. • Public and private contractors, subcontractors and vendors. • Physicians and other providers who receive Federal financial

assistance from HHS


Health Care organizations must:

Standard 4. offer and provide language assistance services, at no cost to each patient/consumer, at all points of contact, timely and during all hours of operation

Standard 5. provide to patients/consumers in their preferred language both verbal offers and written notices informing them of their right to receive language assistance services

Standard 6. assure the competence of language assistance provided to limited English proficient patients/consumers by interpreters and bilingual staff

Standard 7. make available easily understood patient-related materials and post signage in the languages of the commonly encountered groups and/or groups represented in the service area

CLAS Standards 4-7 are enforceable under Title VI of the Civil Rights Act of 1964


Data Source: 34 CFR 300.322 Parent Participation, subsection (d)

“The public agency must take whatever action is necessary to ensure that the parent understands the proceedings of the IEP Team meeting, including arranging for an interpreter for parents with deafness or whose native language is other than English.”

IDEA Requires


Under Section 504 and Title VI, a student’s language proficiency and English Language Learner (ELL) status is part of a student’s cultural background that needs to be considered in order to make appropriate special education evaluation and placement determinations.

Multiple Legal Mandates

Data Source: Section 504 of the Rehabilitation Act, 1973Slide Source:© 2011 - National Center for Cultural Competence


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Characteristics of Culturally & Linguistically Compete Organizations

philosophy

mission statement policy, structures, procedures, practices diverse, knowledgeable & skilled workforce

dedicated resources & incentivescommunity engagement & partnershipspublish & disseminate

advocacy

Characteristics of Culturally Characteristics of Culturally and Linguistically and Linguistically Competent Competent Organizations and SystemsOrganizations and Systems


Cultural and Linguistic Competencewithin the Context of Organizational Change


Our state still struggles with having members of different cultures at top levels of system building. It is hard to fully embrace these tenets without representation. Can you comment on how a state could become authentically competent without that? It seems that “the choir” is often in the audience of meetings such as these, but not necessarily the people who make the calls at the state level.

Also, can you please address poverty as a cultural barrier as well?

Kelly Perez, Denver Early Childhood Council, Colorado


Considering Cultural & Linguistic Competency within the Context of Organizational Change

Does making progress require changes in people’s values, attitudes

and or habits of behaviors?

Adaptive Challenge vs.

Technical Challenge

Reference: Heifetz, R.A. (1994). Leadership Without Easy Answers. Cambridge, MA: TheBelknap Press of Harvard University Press


Organizational Change Theories Applied to Cultural & Linguistic Competency

Resistance is a characteristic of any major organizational change effort and a major reason why organizational change efforts fail. (Prochaska, Prochaska and Levesque, 2001).

Resistance should be expected in different stages of multicultural organizational change because the topics of prejudice, discrimination and oppression are controversial and emotionally charged. (Brantley, Frost and Razak, 1996).

The Transtheoretical Model of Change suggests that it is counterproductive to forge ahead with action without addressing issues such as resistance, that stand in the way of individual and organizational readiness for change.

Data Source:Mayeno, L. Multicultural Organizational Development: A Resource for Health Equity, in Cultural Competence in Health Care Series, The California Endowment and Compasspoint Nonprofit Services, April 2007.


What policy supports can we advocate for that will guarantee or increase the likelihood that families will have access to culturally and linguistically competent staff in the programs in which they participate? Carol Brunson Day, National Black Child Development Institute, Washington, DC


A WORD ABOUT POWER…real and perceived

power overpower withinpower topower with


T.D. Goode Slide Source:© 2011 - National Center for Cultural Competence

Achieving cultural and linguistic

competence in systems supporting

healthy mental development for

young children and their families

What will it take?


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LESSONS OF THE JOURNEY

T.D. Goode

Leadership

Shared Ownership

The ISMs: Confronting the Undercurrents

Keeping it Real

Weave into the Fabric of the Organization


Cultural competence and linguistic competence

are a life’s journey …not a destination

Safe travels!

T.D. Goode


CONTACT US National Center for Cultural Competence

http://[email protected]

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