Culture, language and

Supported Employment

June 8, 2010

APSE 2010 Conference

Atlanta, Georgia

Pierluigi Mancini, Ph.D.

Supported Employment

Supported Employment must pay careful

attention to issues of ethnic and cultural

sensitivity and overall cultural competence.

We know anecdotally that culture and language

pose significant barriers to providing

supported employment in some populations.

Most research on the effectiveness of supported

employment comes from the United States.

Supported Employment

Supported employment is an evidence-

based practice that has proved to be

consistently more effective than

conventional vocational rehabilitation in

helping people with severe mental illness

find and sustain competitive employment.

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CULTURAL COMPETENCE

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Cultural Competence

What is Culture?

Culture is defined by Cross, Bazron,

Dennis, and Isaacs (1989) as, "the integrated pattern of human behavior that includes thoughts, communications, actions, customs, beliefs, values, and institutions of a racial, ethnic, religious, or social group."

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Cultural Competence

What is Cultural Competence?

Cultural Competence is a set of values,

behaviors, attitudes and practices within a

system, organization, program, or among

individuals that enables them to work

effectively across cultures

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The Cultural Competence Continuum

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Cultural Competence

Cultural Destructiveness: forced assimilation, subjugation, rights and privileges for dominant groups only

Cultural Incapacity: racism, maintain stereotypes, unfair hiring practices

Cultural Blindness: differences ignored, “treat everyone the same”, only meet needs of dominant groups

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Cultural Competence

Cultural Pre-competence: explore cultural

issues, are committed, assess needs of

organization and individuals

Cultural Competence: recognize individual

and cultural differences, seek advice from

diverse groups, hire culturally unbiased

staff

Cultural proficiency: implement changes to

improve services based upon cultural

needs, do research and teach

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Cultural Competence

Acquiring Cultural Competence

Starts with Awareness

Grows with Knowledge

Enhanced with Specific Skills

Polished through Cross-Cultural

Encounters

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CULTURAL DIMENSIONS

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Language

Language

Monolingual

Bilingual

Mixed

Linguistic differences exist between

countries and within countries.

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LanguageThe degree to which a patient or staff

member is fluent in English, or any other

language you speak, will have a bearing

on your interactions.

A prime factor affecting this communication

is your attitude toward people who speak

limited English.

How open are you to working with people

who speak with accents?

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Cultural Dimensions

Time orientation (here and now)

Psychological Support System

Patterns of immigration

Political relationship (US vs. country of

origin)

Personal conditions affecting quality of life

Geographically and Linguistically

segregated.

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Cultural Dimensions

Level of Education (Parent/child)

Verbal Communication

Nonverbal Communication

Gender Roles

Religion

Names and Surnames

Birth Date

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BARRIERS

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Barriers to Services

Communication

Different cultural explanations for

the problems

Inability to find culturally competent

services

Mistrust

Cost

Employer Bias

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Barriers to ServicesLEP

Accessibility

Availability

Affordability

Acceptability

Appropriate

Adaptable

Systemic/

Organizational/

Structural

Clinical/Socio Cultural

Intergenerational

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Limited English Proficiency

The ramifications of poor linguistic access

include

Decreased access to services,

Poor comprehension,

Low satisfaction,

Reduced quality of care and

An increase in health care costs.

Services must be Appropriate and Adaptable

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Cultural Influences to receiving services

School

Church

Social CommunityEthnic Community

Family

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Cultural Influences… Culture reflects the values, norms and beliefs of

a group.

The “group” may be:

The family

The Community

An ethnic or racial group

Any number of peer or interest groups

“Culture” overlaps considerably with “Social

Environment” in influencing the health beliefs of

patients.

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Work & Income

Ability to

Navigate

Systems

Spiritual

Activities

Adequacy of

Housing

Family & Friends

Support SystemTransportation

Proximity to

Pharmacy,

Grocery,

Services

Nutrition

Recreation

Insurance

Awareness of

Services

Social

influences

on ability

to

access

healthcare

ACCULTURATION & ASSIMILATION

Factors Affecting Acculturation

Ties with

Family

Reason for

Immigration

Educational

Level

History of

Cultural Group

In the

Community

Time in

Country

Employment

Level of

Involvement

In culture of

origin

Language

Acculturation

Assimilation

Noun: 1a. The act or process of assimilating. 1b.

The state of being assimilated. 2. Physiology the

conversion of nutriments into living tissue;

constructive metabolism. 2. Linguistics the

process by which a sound is modified so that it

becomes similar or identical to an adjacent or

nearby sound. For example, the prefix in- becomes

im- in impossible by assimilation to the labial p of

possible. 4. The process whereby a minority

group gradually adopts the customs and

attitudes of the prevailing culture.

Acculturation

Ac-cul-tur-a-tion

Noun: 1. The modification of a group or

individual as a result of contact with a

different culture. 2. The process by which

the culture of a particular society is instilled

in a human from infancy onward.

Acculturation LevelsDepend on a combination of socio-economic

characteristics such as:

Education and income,

English proficiency,

Years of U.S. residence,

Geographic location, and employment.

It determines how well immigrants will

respond to agency outreach or demonstrate

need to modify efforts.

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CULTURAL FORMULATION

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Cultural Formulation

Cultural Identity of the individual

Ethnic or cultural reference group

Degree of involvement with both origin and host cultures

Language abilities, use and preference

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Cultural Formulation

Cultural explanation of individual’s illness

Idioms of distress through which symptoms are communicated

Meaning and perceived severity of individual’s symptoms

Local illness category ( i.e. Susto)

Perceived causes

Current preference of provider (professional or popular)

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Cultural Formulation

Cultural factors related to psychosocial

environment and levels of functioning

Cultural interpretation of social stressors,

available social supports and level of

function and disability.

Religion and kin networks providing

emotional, instrumental and informational

support.

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Cultural Formulation

Cultural elements of the relationship between individual and clinician

Culture and Social status

Difficulty in communicating

Negotiating appropriate relationship or level of intimacy

Whether behavior is normative or pathological

Overall cultural assessment for diagnosis and care

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CROSS CULTURAL COMMUNICATION

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Cross Cultural Communication

Need to communicate effectively

across cultures

We are rarely taught how to

communicate effectively

Communication is the product of

culture

Most conflicts involve

miscommunication

The problem with communication is theAssumption that it is

happening.

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Aspects of interacting & sharing information influenced by culture

Directness

Gestures & facial expressions

Distance

Touch

Degree of formality

Forms of address

Pace & pitch

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Barriers to Cross Cultural CommunicationAssumed Similarities

Nonverbal communication

Verbal Language

Tendency to evaluate

Preconceptions and Stereotypes

CULTURALLY COMPETENT SERVICES

Culturally Competent Systems

Value differences and similarities among all people.

Understand and effectively respond to cultural differences.

Engage in cultural self-assessment at the individual and organizational levels.

Make adaptations to the delivery of services and enabling supports.

Institutionalize cultural knowledge.

Cultural Competence at the Individual level

An examination of one’s attitude and

values and the acquisition of the

values, knowledge, skills and attributes

that will allow an individual to work

appropriately in cross cultural

situations.

Challenge to take the online cultural

competence self-assessment?

https://www4.georgetown.edu/uis/keybrid

ge/keyform/form.cfm?formID=277

MUCHAS THANK YOU!