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OCTOBER 2002 VOLUME 5, ISSUE 10 PLEASE COPY OR POST

Ideas for Treatment Improvement

Cultural Competence Issues

Northwest Frontier

Addiction Technology

Transfer Center

3414 Cherry Ave NE, Suite 100Salem OR 97303

Phone: (503) 373-1322

FAX: (503) 373-7348

A project of

Oregon Health &Science University

Steve Gallon, Ph.D.,Project Director

Mary Ann e Bryan, [email protected]

Be sure to check out

our web page at:

http://www.open.org/nfatc

Unifying science,

education and

services to

transform lives

Our most basic common l ink is

that we all inhabit thi s planet. We

all breathe the same air . We all

cheri sh our children s futur e. And

we are all mor tal.

John F . Kennedy (1917-1963)

The next three issues of the Addic-

tion Messenger will focus on

information regarding cultural

competency issues for counselors and

treatment organizations. As a substance

abuse professional the client population ofyour agency is probably representative of

demographics of our society. Society

today is both multi-ethnic and

multicultural. You may have questions

about your clients culture and how you

can become more culturally sensitive or

how your agency can develop cultural

competency. This series of articles will

address these questions.

Ethnic and cultural disparities exist in

many aspects of our society includinghealth care. Culture influences the way

clients respond to health care provision

and can impact the delivery of those

services. In order to better respond to

client needs, treatment programs and

substance abuse professionals can foster

their understanding of diversity and

further their appreciation and acknowledg-

ment of the differences in their clientele.

The following paragraphs will provide

definitions for terminology related to

culture. Cross, T. (1989) gives the

following definitions:

Cultur al Knowledge

Familiarization with selected cultural

characteristics, history, values, belief

systems, and behaviors of the members of

another ethnic group

Cul tural Awareness

Development of a sensitivity and under-

standing of another ethnic group. This

involves internal changes in attitudes and

values and refers to qualities of openness

and flexibility in relation to others. Cul-tural awareness must be supplemented

with cultural knowledge.

Cul tur al Sensitivity

Knowing that cultural differences as well

as similarities exist, without assigning

values (better or worse, right or wrong) to

those cultural differences.

Cul tur al Competence

A set of congruent behaviors, attitudes

and policies in an agency that enable that

agency to work effectively in cross-

cultural situations. Culture implies the

integrated pattern of human thoughts,

communications, actions, customs,

beliefs, values, and institutions of a racial,

ethnic, religious or social group. Compe-

tence implies having a capacity to

function effectively. Cultural compe-

tency emphasizes the idea of effectively

operating in different cultural contexts

while cultural knowledge, awareness and

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NFATTC ADDICTION MESSENGER OCTOBER 20022PAGEsensitivity do not include this

concept.

Culture

A groups shared conception of

reality, created by members of the

group living together over genera-tions, through their language,

institutions, arts, values, beliefs,

experiences, work and play.

Sub-Culture

A group of people within a larger

sociopolitical structure who share

cultural characteristics which are

distinctive enough to distinguish it

from the others.

EthnicityThe way in which groups of people

retain and practice customs,

language, and social views of their

group.

Cultivating Cultural

Competence

On an individual level within your

agency there are several things that

can be done to cultivate cultural

competence:Value diversity by considering

differences as strengths rather than

interact. Individuals may not feel

in their comfort zones but it should

not cause division.

Institutionalize cultural knowl-

edge through the encouragement of

the agencys administration.

Adapt the delivery of services to

reflect an understanding of cultural

diversity through making changes

to meet the needs of your clients.

Models of Cultural Com-

petence

A culturally competent model of

treatment acknowledges the

cultural strengths, values and

experiences of the client whileencouraging behavioral and

attitudinal changes. Characteristics

of culturally responsive services

include:

Staff knowledge of the native

language of the client,

Staff sensitivity to the cultural

nuances of the client population,

Staff that is representative of the

population,

Treatment services that reflect

cultural values and treatment needsof the client population, and

Representation of the client

population in decision making and

policy implementation within the

agency.

The culturally competent agency

should implement cultural compe-

tence at various levels within the

agency, such as attitude, practice,

policy and procedure.

Josepha Campinha-Bacote (2002),

Ph.D., RN, wrote an article titled

The Process of Cultural Compe-tence in the Delivery of Healthcare

Services which describes a new

model of cultural competence.

The key points of this model

include five constructs of cultural

competence:

Cul tural Awareness the process

of conducting a self-examination of

biases of other cultures and an in-

depth exploration of ones cultural

and professional background.Cultur al Knowledge process of

seeking cultural information as well

as biological variations among

specific ethnic groups.

Cultural Skill ability to conduct

a cultural assessment to collect

relevant cultural data regarding

clients concerns as well as con-

ducting a culturally-based physical

assessment.

Cultur al Encounter the process

which encourages the counselor todirectly engage in face-to-face

cultural interactions in order to

modify their existing beliefs about a

particular group to prevent stereo-

typing.

Cultur al Desir e- the motivation

to want to engage in the process

of becoming culturally aware,

knowledgeable, skillful and capable

of seeking cultural encounters.

Campinha-Bacote notes thatcultural desire is the pivotal

construct of cultural competence

that provides the energy source and

foundation for the journey towards

cultural competency.

Another model of cultural compe-

tence, offered by Dr. Terry Cross

(1989) at the University of Port-

land, Portland, Oregon, includes

cultural destructiveness as the

Diversity Patterns in Our Region

AK HI ID OR WA

Indian/Alaskan 15.6% .3% 1.4% 1.3% 1.6%

Asian .4% 41.6% .9% 2.9% 5.5%

African American 3.5% 1.8% .4% 1.6% 3.2%

Hispanic 4.1% 7.2% 7.9% 8% 7.5%

Hawaiian/Pacific Islander .5 % 9.4% .1% .2% .4%

tolerating them.

Conduct a cultural self-assess-

ment.

Be awareness of dynamics when

people from different cultures

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NFATTC ADDICTION MESSENGER OCTOBER 2002

Sources:

3PAGE

Cultural Competence:

Agency Awareness

Next I ssue:

lowest level of competency and

advanced competence as the

highest. The definitions are summa-

rized below.

Cultur al Proficiency engaging in

research about cultural variety and

differences.

Cul tur al competence accepting,

appreciating and accommodating

cultural differences. Including in-

formation for trainings that acknowl-

edges and values differences.

Pre-competence recognizing own

deficiencies in cultural awareness

and the importance of cultural

differences and awareness. Having

the commitment to correct the

deficiencies.

Cultur al blindness those individu-

als stating they are color blind and

dont see color.

Cultur al i ncapacity individuals

unable to accept or respond to

cultural diversity existing in a group.Cul tur al destructi veness relating

to culture in an anti-cultural way

through negative relationships with

other cultures or attempting to

eliminate them.

The Myth of Cultural Com-

petence?

In an article written by Ruth G.

Dean (2001) titled The Myth of

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Cross-Cultural Competence takes

a different view of cultural compe-

tence. The authors main concern

is how does a person become com-

petent at something (culture) that is

continually changing, and how do

we develop a focus that includes

ourselves as having differences,

beliefs, and biases that are inevita-

bly active? Dean concludes that

people working in cross-cultural

situations consider a model in

which maintaining an awarenessof ones lack of competence is the

goal rather than the establishment

of competence. With lack of

competence as the focus, a dif-

ferent view of practicing across

cultures emerges. She suggests

that reading about other cultures,

becoming informed of ones own

cultural baggage and trying to be-

come aware of when it interferes

with the ability to understand

anothers point of view is helpful

but that we must recognize how

difficult it is to separate ourselves

from our own cultural baggage.

Keeping that awareness in our

conscience will hopefully limit its

impact on our work.

Improving Patient Care (2000).

Cul tur al Competence. Retrieved

September 16, 2002, from

World Wide Web:

http://www.aafp.org/fpm/20001000/5&cult

Center for Substance Abuse Treatment

(1999). Cul tur al I ssues in Substance

Abuse Tr eatment. Rockville, Maryland

Transcultural Care (2002). The

Process of Cu ltu ral Competence in

the H ealth care Services. Retrieved

September 16, 2002, from

World Wide Web:

http://www.transculturalcare.net

Dean, Ruth, G. (2001) The Myth of

Cross-Cultural Competence Famili es in

Society: The Journal of Contemporary

Human Services, Vol. 82, No. 6, pp.

623-630 .

Cross, T. et al (1989). Towards a

Culturally Competent System of Care

Vol. 1, Washington, D.C.: Georgetown

University Child Development Center,

CASSP Technical Assistance Center

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2 Continuing Education hours for $25

Earn 2Continui ng Education Hours - NAADAC Approvedby reading a series of three Addiction Messengers (AM)

If you wish to receive continuing education hours for reading the AM just fill out the registration form below

complete the pre-test on the reverse side of this page, and return both to NFATTC with a feepayment of $25 (make

checks payable to: NFATTC, please). We will send you a free copy of the main source of material information. Youmust then read the three monthly issues of the Addiction Messenger and the reference material for the series. The las

issue in the series will have a post-test in it. You will need to complete the post-test (along wi th a 100 word shor

essay question regarding your reaction to the mater ial )and return it to the NFATTC. You will receive, by return

mail, a certificate stating that you have completed 2 Continuing Education hours. Four continuing education series

are offered each year. Completing a series of three issues will earn you 2 CE hours (or a total of 8 if you do all four

series in 2002). You may complete as many series as you wish.

Series 1includes Vol. 4, Issues 1-3 Evidence-Based Treatment Approaches

Series 2includes Vol. 4, Issues 4-6 What Works for Offenders?

Series 3includes Vol. 4, Issues 7-9 Manual-Based Group Skills

Series 4includes Vol. 4, Issues 10-12 Preparing Clients for Change, What Is A Woman Sensitive

Program? and Naltrexone Facts

Series 5 includes Vol. 5, Issues 1-3 Methamphetamine: Myths & Facts

Series 6 includes Vol. 5, Issues 4-6 Co-Occurring Disorders

Series 7 includes Vol. 5, Issues 7-9 Trauma Issues

______________________________________________________________________________

Registration Form for Series 8 - Cultural Competency Issues

Name______________________________________________________________

Address____________________________________________________________

City/State/Zip_______________________________________________________

Phone______________________________________________________________

What is your highest degree status? (check one)

____ No high school diploma or equivalent ____ Associates degree ____ Masters degree

____ High school diploma or equivalent ____ Bachelors degree ____ Doctoral degree/equivalent

____ Some college, but no degree ____ Other (specify)______________________________________

What is your discipline or profession? (check all that apply)

____ Addictions Counseling ____ Other Counseling ____ Education

____ Vocational Rehabilitation ____ Criminal Justice ____ Psychology

____ Social Work/Human Services ____ Physician Assistant ____Medicine: Primary Care

____ Medicine: Psychiatry ____ Medicine: Other ____ Nurse____ Nurse Practitioner ____ Administration ____ None, unemployed

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Return your pre-test by mail or FAX at (503) 373-7348

Northwest Frontier ATTC

3414 Cherry Ave. NE, Suite 100, Salem, OR 97303

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Pre-TestSeries 8

Cir cle the corr ect answer for each question

#1

A set of congruent behaviors, attitudes and policies that

enable an agency to work effectively in cross-culturalsituations defines:a. Cultural awareness

b. Cultural competence

c. Cultural knowledge

d. Cultural sensitivity

e. None of the above

#2

A definition of ethnicity would include the way in which

groups of people retain and practice customs, language, and

social views of their group.

True False

#3

Characteristics of providing culturally responsive services

would include:

a. sensitivity to cultural nuances of the client population.

b. having staff that is representative of the population.

c. providing services that dont reflect cultural values.

d. none of the above

e. a and b

#4

Cultural competence:

a. does not influence the development of a treatment plan.b. does not facilitate the acccuracy of a diagnosis

c. allows the provider to obtain more specific and complete

information

d. b and c

e. all of the above

#5


a. improves the overall communication and clinical interac-

tions between client and provider.

b. leads to improved diagnosis and treatment plans.

c. does not lead to greater client compliance.

d. a and be. b and c

#6

Josepha Campinha-Bacote describes a new model of

cultural competence that includes only the following:cultural awareness, cultural sensitivity, and cultural skills.

True False

#7

In Ruth G. Deans article, The Myth of Cross-Cultural

Competence, she suggests :

a. maintaining an awareness of ones lack of cultural

competence is a goal.

b. that people dont have cultural bggage.

c. that it is difficult to become competent at something

(culture) that is continually changing.

d. a and b

e. a and c

#8

Josepha Campinha-Bacote notes that the pivotal construct of

cultural competence that provides the energy source and

foundation for the journey towards cultural competence

comes from:

a. cultural encounters

b. cultural desire

c. cultural knowledge

d. a and b

e. none of the above

#9

A culturally competent agency should implement cultural

competence at various levels such as:

a. agency attitudes

b. agency practices

c. agency policies and procedures

d. a and b

e. all of the above

#10

Becoming a culturally sensitive and responsive counselor is

best conceptualized as a process.

True False

Mail or FAX your completed test to NFATTC

Northwest Frontier ATTC, 3414 Cherry Ave. NE, Suite 100, Salem, OR 97303

FAX: (503) 373-7348

You can still register for continuing education hours forSer ies 1, 2, 3, 4, 5, 6 or 7

Contact Mary Anne Br yan at (503) 373-1322 ext. 224

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NOVEMBER 2002 VOLUME 5, ISSUE 11 PLEASE COPY OR POST


Northwest Frontier


Transfer Center


Phone: (503) 373-1322

FAX: (503) 373-7348

A project of





our web page at:

http://www.open.org/nfatc

Unifying science,

education and

services to

transform lives

Cultu ral competence is the

process of becoming;

not a state of being...

Josepha Campinha-Bacote, Ph.D.

This issue of the Addiction Messen-

ger focuses on issues that can be

important to increasing cultural

competence in substance abuse treatment

organizations. Since todays society is

becoming increasingly both multi-ethnic

and multicultural there is a need for

everyone to continue their growth ofknowledge in this area. A key aspect of

becoming culturally competent is to be

aware of the great diversity among

individuals, even in the smallest cultural

group. Populations include people from

different races, cultures, ethnic back-

grounds, religions, ages, genders, sexual

orientations as well as physical and mental

abilities.

Why Is Cultural Competence

Needed?

The National Center for Cultural Compe-

tence (NCCC) at Georgetown University

(1999) notes that the incorporation of

culturally competent approaches within

heath care systems remains a great

challenge for many states and communi-

ties. Organizations and programs are

struggling with how best to respond to the

needs of diverse groups. The need for

Cultural Competence: Agency Action

cultural competence in health care sys-

tems, according to NCCC, includes but is

not limited to the following observations:

* The perception of illness and diseaseand their causes varies by culture,

* Diverse belief systems exist related to

health, healing, and wellness,

* Culture influences help seeking behav-

iors and attitudes toward health care

providers,

* Individual preferences affect traditional

and non-traditional approaches to health

care,

* Patients must overcome personalexperiences of bias within health care

systems, and

* Health care providers from culturally

and linguistically diverse groups are under-

represented in the current service delivery

system.

These issues substantiate the need for

health care programs to develop policies,

practices and procedures that support the

delivery of culturally competent services.

The National Center for Cultural Compe-

tence has developed and outlined thefollowing six key reasons for the incorpo-

ration of cultural competence in organiza-

tions:

1. To Respond to Curr ent and Projected

Demographi c Changes in the United

States.

Data from the 2000 census notes that the

number of people who speak a language

other than English grew 48% during the

previous ten years. Within this group

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NFATTC ADDICTION MESSENGER NOVEMBER 20022PAGE21.3 million report having trouble

speaking English (an increase of

52% since 1990). Currently the

foreign-born population of the

United States is larger than it has

been in the last five decades and

the trend is expected to continue.

2. To El imi nate Long-Standing

Dispariti es in the Health Status of

People of Diverse Racial, E thni c,

and Cul tural Backgrounds.

The divisions of race, ethnicity and

culture are sharply drawn with

regard to health in the United

States. There continues to be

disparities in the incidence of illness

and death among diverse groups.

Six areas of health status have been

targeted by the Federal govern-

ment: cancer, cardiovascular

disease, infant mortality, diabetes,

HIV/AIDS, and child and adult

immunizations.

3. To Improve the Quali ty of

Services and H ealth Outcomes.

Differences among people can

stem from nationality, ethnicity,

and culture as well as family

background and personal experi-

ences. These differences affect

beliefs and behaviors related to

health issues of both clients and

providers. The provision of

culturally competent health care

services includes understanding of:

* Beliefs, values, traditions and

practices of a culture;

* Culturally-defined, health-related

needs of individuals, families andcommunities;

* Culturally-based belief systems

related to the etiology of illness and

disease and to health and healing;

and

* Attitudes towards seeking help

from health care providers.

4. To Meet Legislative, Regula-

tory and Accreditation M andates.

Organizations and programs have

multiple responsibilities to comply

with Federal, state and local

regulations in the delivery of health

services. The Healthy People Year

2000/2010 Objectives, among

other national efforts, includes an

emphasis on cultural competency

as an integral component of health

service delivery.

5. To Gain a Competi tive Edge

I n the Market Place.

Culturally appropriate treatment

services can increase retention and

access to care, expand recruitment

and increase the satisfaction of

consumers. Reaching these

outcomes can include integrating

culturally competent policies,

structures and practices within

agencies.

6. To Decrease the Likelihood of

Li abil ity/Malpractice Claims.

A lack of awareness about cultural

differences could result in liability.

Communicating with clients may

be even more challenging when

there are cultural and linguistic

barriers present.

The NCCC notes that there are a

lack of policies, planning proce-

dures and institutional structures in

many organizations that support

culturally competent practices. A

cultural competency framework

used by NCCC is based on the

following beliefs:

* There is a defined set of values,

principles, structures, attitudes and

practices inherent in a culturally

competent system of care;

* Cultural competence at both the

organizational and individual levels

is an ongoing developmental

process; and

* Cultural competence must be

systematically incorporated at

every level of an organization,

including the policy making,

administrative, practice and

consumer/family levels.

Avoid Stereotyping

While there are many similarities

among people from the same

cultural background we also need

to be aware of the differences and

variabilities that exist within a

cultural group. In other words,

what may be true for most or some

individuals from a particular region

or culture may not be true for all

the people of that group. Diversity

exists within all groups of people.

This knowledge will lessen the

possible creation or reinforcement

of a cultural stereotype.

All people have unique personal

histories, belief systems, andcommunication styles. Ones

development is impacted by accul-

turation (merging of cultures that

occurs through prolonged contact)

and assimilation (responding to

new situations in conformity). Your

agency may have clients who have

recently immigrated to the United

States and others who have been

here and still identify with their

culture of origin.

Some other questions that contrib-

ute to differences within groups

include:

* People from rural areas may be

living a more traditional lifestyle

than people who emigrate to the

United States from urban areas.

* Economic status and education

can vary greatly among people

from the same country.

* People from the same country

may have migrated to the United

States for very different reasons,

including seeking economic

opportunities, escaping religious or

ethnic persecution, fleeing civil

strife, or joining relatives in

America.

* There are important intra-region

and intra-group variations among

people from the same country, and

cultural variations may be marked

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NFATTC ADDICTION MESSENGER NOVEMBER 2002

Source:

Levin, et al (2000). Appendix: Useful Clinical

Interviewing Mnemonics. Patient Care Specia

Issue, Caring for Diverse Populations: Breaking

Down Barriers

The Providers Guide to Quality & Culture (2000).

Avoi di ng St ero ty pes . Retrieved 10/21/02 from

World Wide Web:

http://erc.msh.org/

National Center for Cultural Competence (2000).

Rational for Cultural Competence in Primary

Health Care. Retrieved10/18/02 from

World Wide Web:

www.georgetown.edu/research/

3PAGE

Cultural Competence:

Counselor Approaches

Next Issue:





Name:_______________________________________________________________________________________


Mailing Address: _____________________________________________________________________________

Phone: ______________________________________________________________________________________

between generations.

Traditional Healing IssuesYour agency may have some

clients who choose to use familiar

folk or traditional cultural treatment

practices in conjunction with your

organizations treatment strategy.

It is important to show tolerance of

and respect for this issue to fully

understand the client and provide

appropriate treatment.

Discussing client beliefs about the

possible causes of an illness and

the remedies tried previously can

be helpful in developing a treat-

ment plan. It is also important to

ask whether the strategy developed

to assist the client conflicts in some

way with personal beliefs and

traditional practices.

The mnemonic framework ETH-

NIC created by Levin, et al

(2000) is a tool that can be used by

care providers who work with

clients who use folk or traditional

practices to provide culturally

competent care. A summary of

questions and issues within the

framework include:

Explanation:

What do you think may be the

reason you have this problem?

What do friends, family, and others

say about your symptoms? Do

you know anyone else who has

had or who now has this kind of

problem? Have you heard about/

read about/seen it on TV/radio/

newspaper? If clients cannot offer

an explanation ask what most

concerns them about their problem.

Treatment:

What kinds of medicines, home

remedies, or other treatments have

you tried for this illness? Is there

anything you eat, drink, or do (oravoid) on a regular basis to stay

healthy? Tell me about it. What

kind of treatment are you seeking

from me?

Healers:Have you sought any advice from

alternative or folk healers, friends,

or other people who are not

doctors on help with your prob-

lems? Tell me about it.

Negotiate:Try to find options that will be

mutually acceptable to you and the

client that incorporate the clients

beliefs, rather than contradicting

them.

Intervention:Determine an intervention with

your client that may incorporate

alternative treatments, spirituality,

traditional healers, science-based

alternatives and other cultural

practices.

Collaboration:Collaborate with the client, family

members, other health care team

members, healers, and community

resources.

The standard for addiction treat-

ment should be inclusive of these

cultural considerations. When they

are seen as an essential part of

treatment planning, only then do

we begin to truly individualize care.

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DECEMBER 2002 VOLUME 5, ISSUE 12 PLEASE COPY OR POST


Cultural Competence: Counselor Approaches

Northwest Frontier


Transfer Center


Phone: (503) 373-1322

FAX: (503) 373-7348

A project of





our web page at:

http://www.nfattc.com

Unifying science,

education and

services to

transform lives

Recogni ze dif ferences; but bui ld

on simi lari ties...

Josepha Campinha-Bacote, Ph.D.

This final article in our cultural compe-

tency series will provide information

on working with clients from several

cultural backgrounds. General concerns, strat-

egies, challenges, and suggestions for devel-

oping an effective therapeutic relationship will

be addressed. While numerous cultural groups

are represented in our society, this issue fo-

cuses on four of the largest: African Ameri-

cans, American Indian/Alaskan Natives, His-

panic Americans, and Asian American/PacificIslanders. Hopefully, the ideas that appear in

the following paragraphs will inspire creative

and culturally sensitive approaches to treat-

ment planning and delivery.

It is important to keep in mind that diversity

exists within all groups of people. What may

be true for most of the individuals from a par-

ticular cultural group will probably not be ac-

curate for all. Approaching each person as

unique will facilitate your own flexibility and

creativity, and will help you develop a treat-

ment plan that is truly sensitive to the indi-vidual needs of the client.

Cultural Issues in Substance Abuse Treat-

ment (Center for Substance Abuse Treatment

, 1999) was used as a major resource for the

following information. Due to space limita-

tions, the discussion is brief and meant to

stimulate your thinking. For more detailed in-

formation you may order a copy from the Na-

tional Clearinghouse for Alcohol and Drug

Information (NCADI) at (800) 729-6686.

African AmericanThe vast majority of African Americans do not

engage in substance abuse. For those who do,

the patterns vary by age with many tending not

to begin use until after age 21. Initially mari-

juana is one of the most commonly used sub-stances. There appears to be a tendency to

progress from marijuana to heroin.

Health and Social I ssuesAfrican Americans have higher rates of alco-

hol related medical problems than their white

counterparts even though whites have a higher

rate of alcohol use and abuse. HIV infection

is the fourth leading cause of death in African

Americans. HIV/AIDS disproportionately af-

fect African Americans in general and espec-

ially injection drug users. Social repercus-

sions are serious with an estimated half ofAfrican American men in prison serving drug-

related sentences.

Tr eatment ConcernsIssues of trust are the core to service delivery

problems. If a non-African American counse-

lor does not possess a cultural knowledge base,

negative attributions and stereotypes may be

perceived and/or influence the interactions

with clients. For example, many women who

are heads of households have been categorized

as dysfunctional. Such families often prac-

tice a communal form of child rearing. Ex-

tended families are often referred to as a kin-

ship network. The African proverb, It takes a

whole village to raise a child reflects this tra-

dition.

Stereotyping and institutional racism have pro-

found effects on treatm ent access and comple-

tion. Negative experiences with welfare and

social system s have caused m any of these

fam ilies and individuals to be hesitant in pro-

viding personal inform ation. Questions m ay

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NFATTC ADDICTION MESSENGER DECEMBER 20022PAGE

Cultural Competency Websites

DHHS Initiative to Eliminate Racial and Ethnic Disparities in Health

http:www.raceandhealth.hhs.gov

ETHNOMED

http:www.hslib.washington.edu/clinical/ethnomed/index.html

DIVERSITYRX

http:www.diversityrx.org

Cross Cultural Health Care

http:www.xculture.org

Transcultural Care Associates

http:www.transculturalcare.net

National Center for Cultural Competence

http:www.georgetown.edu/research/gucdc

be viewed as prying if an attempt at

building trust with your client has not

been established. Church affiliation

can be a valuable resource to the cli-

ent. Participation in church activities

can improve a persons recovery and

decrease the chance of relapse.

Some treatment programs develop an

Afrocentric approach, which combines

best practices with an African value

system. Such programs emphasize

oneness of spirit between people and

nature. African proverbs can be used

to enhance treatment through increas-

ing insight and broadening perspectives

and thinking styles. Examples of prov-

erbs are:

The ruin of a nation begins in the

homes of its people (Ashanti)

He who conceals his disease cannot

expect to be cured (Ethiopia)

Even an ant may harm an elephant

(Zululand)

American Indian/AlaskanNativeWith over 400 American Indian tribes,

it is important that they not be placed

into a large melting pot. Each has its

own beliefs, ceremonies, and tradi-tions. Alcohol is the drug most fre-

quently used by American Indians.

They tend to begin using alcohol and

illicit drugs at an earlier age than other

cultural groups. Youth frequently

abuse inhalants.

Health and Social I ssues

The negative health and social conse-

quences that American Indians suffer

because of substance abuse are both

quantitatively and qualitatively higher

than other cultural groups. Health

problems include: heart disease, can-

cer, diabetes, injuries and death. More

die from suicide, homicide and alco-

hol-related injuries than any other

group. Women tend to die at higher

rates due to alcohol-involved causes

than women in other cultural groups.

Treatment Concerns

Using culturally sensitive approaches

that incorporate and reinforce tradi-

tional lifestyles increases retention

rates among Alaskan Natives, for whom

binge drinking is a common pattern.

The main barrier affecting treatment is

the lack of social services. Clients liv-

ing in remote areas often resist leav-

ing their communities to seek treat-

ment. Confrontational methods (even

direct eye contact) with this group are

both ineffective and potentially dam-

aging. Situational role modeling and

practice have been found to be useful

and effective relapse prevention tech-

niques.

The use of counseling, psychotherapy

and referral to 12-Step programs, while

effective in the mainstream, may not

appeal to American Indian clients who

often take a long time to disclose per-

sonal information about their lives.

Being aware of historic issues sur-

rounding trust is important while es-

tablishing a therapeutic relationship

with the client. It is important to use a

holistic approach that integrates the useof traditional ceremonies, beliefs, val-

ues and practices in treatment. A cul-

turally competent treatment plan would

include contact with immediate and ex-

tended family members and collabo-

ration with and referral to community

organizations. Traditional practices

that can be used in treatment for

American Indians include:

Talking Circle

The Talking Circle or Talking Stick is a

group activity in which group membersare seated in a circle. The group leader

introduces the Talking Stick and passes

it around the circle. As each member

receives the stick they have the oppor-

tunity to speak freely without fear of

rejection or interruption.

Sweat L odge

The Sweat Lodge is a small dome-

shaped structure with heated rocks in

the center and participants sitting in a

circle around the edge of the lodge.

Water is poured over the rocks to cre-ate steam and prayers are said. The pur-

pose of the Sweat Lodge is to bring par-

ticipants closer to the Creator.

The Good Way

The Good Way promotes spiritual heal-

ing through using traditional culture in

interpreting the 12-Step program. An

example would be - Step 2: I believe

that a greater spirit can help me to re-

gain my responsibilities and model the

life of my forefathers (ancestors).

Hispanic AmericansHispanics tend to use cocaine at higher

rates than African Americans and

Whites. With regard to gender differ-

ences, Hispanic women have lower

substance abuse rates than their male

counterparts. Acculturation may play

a role in this because the longer women

have been in the U.S. culture the more

their use patterns mirror the patterns

8/14/2019 AM v5 Series 4

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NFATTC ADDICTION MESSENGER DECEMBER 2002

Sources:

3PAGE

Treatment Engagement

Issues

Next I ssue:





Name:_______________________________________________________________________________________


Mailing Address: _____________________________________________________________________________

Phone:______________________________________________________________________________________

Center for Substance Abuse Treatment(1999). Cul tur al I ssues in Substance

Abuse Tr eatment. Rockville, Maryland

of women in the general population.

Health and Social I ssuesHispanic Americans have a higher per-

centage of AIDS cases related to in-

jection drug use than the general popu-

lation. Tuberculosis in this group of-

ten parallels injection drug use and HIV

infection in the community.

Tr eatment ConcernsHispanic clients will benefit from

treatment programs that address the

following:

* Language, socioeconomic, cultural

and geographic barriers,

* Immigration status (legal versus

illegal),

* Level of acculturation, and

* Service integration.

Underutilization of treatment pro-

grams by Hispanics can also be linked

to lack of bilingual or bicultural staff.

The Hispanic culture values an empha-

sis on respect and the development of

trust in relationships. Confrontational

approaches used in some programs are

degrading to Hispanic clients and are

destructive to their self-esteem. Treat-ment that focuses on a holistic ap-

proach which integrates traditional val-

ues and beliefs and attends to the de-

velopment of a continuing care plan

that reintegrates the client back into

their community will be beneficial to

tend to have a lower prevalence of sub-

stance abuse than other cultural groups.

For those who do use, abuse patterns

and the drug of choice vary across sub-groups. A clients personal migratory

experience and level of acculturation

can add a unique dimension when con-

sidering their substance abuse history

and appropriate treatment plan.

Health and Social I ssuesSubstance abuse problems are on the

rise with Asian Americans and Pacific

Islanders. The relationship between

substance abuse and crime has been

consistently strong as with other cul-

tural groups. It has been noted that ad-aptation to Western culture has

changed the once hierarchical family

structure, family member interdepen-

dence and self-identity of this groups

youth. This may be a factor in sub-

stance abuse predisposition for them.

Treatment ConcernsThe diversity of Asian Americans and

Pacific Islanders has made providing

culturally competent services to this

group a complex issue. The acknow-

ledgement of a substance abuse prob-lem often leads to a considerable loss

of face and feelings of shame for both

the client and their family. Substance

abuse behaviors may be under reported.

Treatment interventions that exclude or

separate the client from their family

may be resisted. Strategies that appear

to decrease powerful family relation-

ships or that blame the parent will not

be advantageous to treatment. Seek-

ing assistance from a treatment pro-

gram is usually viewed as a last resort

by the family and goes outside of nor-

mal acceptable parameters of a culture

that prefers to handle problems withinthe family.

It is important for treatment providers

to be aware of multiple losses, stress-

related issues and adaptation difficul-

ties for many members of all these

cultural groups. Using interventions

such as psycho-education, role-mod-

eling and practice, and development of

coping skills can be productive strate-

gies that demonstrate respect and an ap-

preciation for cultural differences.

Maintaining an awareness of cultureand developing appropriate treatment

approaches are never ending challenges

for us and can be consistent sources

of satisfaction for both the provider and

the client.

the therapeutic relationship.

Asian American/Pacific

IslandersAsian Americans and Pacific Islanders

8/14/2019 AM v5 Series 4

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Post-TestSeries 8

Cir cle the corr ect answer for each question

#1

A set of congruent behaviors, attitudes and policies that

enable an agency to work effectively in cross-cultural

situations defines:a. Cultural awareness

b. Cultural competence

c. Cultural knowledge

d. Cultural sensitivity

e. None of the above

#2

A definition of ethnicity would include the way in which

groups of people retain and practice customs, language, and

social views of their group.

True False

#3

Characteristics of providing culturally responsive services

would include:

a. sensitivity to cultural nuances of the client population.

b. having staff that is representative of the population.

c. providing services that dont reflect cultural values.

d. none of the above

e. a and b

#4


a. does not influence the development of a treatment plan.

b. does not facilitate the acccuracy of a diagnosisc. allows the provider to obtain more specific and complete

information

d. b and c

e. all of the above

#5


a. improves the overall communication and clinical interac-

tions between client and provider.

b. leads to improved diagnosis and treatment plans.

c. does not lead to greater client compliance.

d. a and b

e. b and c

#6

Josepha Campinha-Bacote describes a new model of

cultural competence that includes only the following:

cultural awareness, cultural sensitivity, and cultural skills. True False

#7

In Ruth G. Deans article, The Myth of Cross-Cultural

Competence, she suggests :

a. maintaining an awareness of ones lack of cultural

competence is a goal.

b. that people dont have cultural bggage.

c. that it is difficult to become competent at something

(culture) that is continually changing.

d. a and b

e. a and c

#8

Josepha Campinha-Bacote notes that the pivotal construct of

cultural competence that provides the energy source and

foundation for the journey towards cultural competence

comes from:

a. cultural encounters

b. cultural desire

c. cultural knowledge

d. a and b

e. none of the above

#9

A culturally competent agency should implement culturalcompetence at various levels such as:

a. agency attitudes

b. agency practices

c. agency policies and procedures

d. a and b

e. all of the above

#10

Is cultural competency a goal of your agency?

True False

FAX: (503) 373-7348

You can still register for continuing education hours forSer ies 1, 2, 3, 4, 5, 6 or 7

Contact Mary Anne Br yan at (503) 373-1322 ext. 224

Mail or FAX your completed test to NFATTC

Northwest Frontier ATTC, 3414 Cherry Ave. NE, Suite 100, Salem, OR 97303

8/14/2019 AM v5 Series 4

13/13

We are interestted in your reactions to the information provided in Series 8of the Addiction

Messenger. As part of your 2 continuing education hours we request that you write a short

response, approximately100 words, regarding Series 8. The following list gives you some sugges-

tions but should not limit your response.

What was your reaction to the concepts presented in Series 8?

How did you react to the amount of information provided?

How will you use this information?Have you shared this information with co-workers?

What information would have liked more detailabout?

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am v5 series 4

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