Integrating Cultural Integrating Cultural Competence into Everyday Competence into Everyday

Practices Practices NAEH Annual Conference

ENDING HOMELESSNESS: THE TIME NOW!!!!!

Amie Parikh, MAAmie Parikh, MACorporate Compliance OfficerCorporate Compliance Officer MTI Residential Services, Inc.MTI Residential Services, Inc.

Miriam E. Delphin, Ph.D.Miriam E. Delphin, Ph.D.Yale University Program for Recovery and Community Yale University Program for Recovery and Community

HealthHealth

Culture Counts: A Call To ActionCulture Counts: A Call To Action

Mental Health: Culture, Race and Ethnicity, Mental Health: Culture, Race and Ethnicity, Supplement to the Surgeon General’s Supplement to the Surgeon General’s Report (2001)Report (2001)

Institute of Medicine: Unequal Treatment Institute of Medicine: Unequal Treatment (2002)(2002)

The President’s New Freedom Commission The President’s New Freedom Commission Report on Mental Health (2003)Report on Mental Health (2003)

Behavioral Health Disparities:Behavioral Health Disparities:Findings of the Surgeon General Findings of the Surgeon General

(2001)(2001) Ethnic & Racial MinoritiesEthnic & Racial Minorities:: Less access to, & availability of, Less access to, & availability of,

behavioral health servicesbehavioral health services Less likely to receive needed behavioral Less likely to receive needed behavioral

health serviceshealth services Less likely to receive high quality Less likely to receive high quality

behavioral health carebehavioral health care Experience a greater burden of disabilityExperience a greater burden of disability

Media Response to the IOM Media Response to the IOM Unequal Unequal Treatment ReportTreatment Report (2002)(2002)

New York Times, March 22, “Subtle Racism in Medicine”

“ . . . a disturbing new study by the Institute of Medicine has concluded that even when members of minority groups have the same incomes, insurance coverage and medical conditions as whites, they receive notably poorer care. Biases, prejudices and negative racial stereotypes, the panel concludes, may be misleading doctors and other health professionals.”

Black and White Differences in Specialty Procedure Utilization Among Medicare Beneficiaries Age 65 and Older, 1993

Black White

Angioplasty (procedures per 1,000 beneficiaries per year)

2.5 5.4

Coronary Artery Bypass Graft Surgery (procedures per 1,000 beneficiaries per year)

1.9 4.8

Mammography (procedures per 100 women per year)

17.1 26.0

Hip Fracture Repair (procedures per 100 women per year)

2.9 7.0

Amputation of All or Part of Limb (procedures per 1,000 beneficiaries per year)

6.7 1.9

Bilateral Orchiectomy (procedures per 1,000 beneficiaries per year)

2.0 0.8

Source: Gornick et al., 1996

The President’s New Freedom The President’s New Freedom Commission Report on Mental Health Commission Report on Mental Health

(2003)(2003)

The Commission declared “…the mental The Commission declared “…the mental health delivery system is fragmented and health delivery system is fragmented and in disarray … lead[ing] to unnecessary and in disarray … lead[ing] to unnecessary and costly disability, homelessness, school costly disability, homelessness, school failure and incarceration.”failure and incarceration.”

““The system has neglected to incorporate The system has neglected to incorporate respect or understanding of the histories, respect or understanding of the histories, traditions, beliefs, languages and value traditions, beliefs, languages and value systems of culturally diverse groups.”systems of culturally diverse groups.”

The President’s New Freedom The President’s New Freedom Commission Report on Mental Health Commission Report on Mental Health

(2003)(2003)

““Striking disparities in mental health Striking disparities in mental health care are found for racial and ethnic care are found for racial and ethnic minorities.”minorities.”

Goal # 3: Disparities in mental Goal # 3: Disparities in mental health services are eliminated.health services are eliminated.

Schizophrenia

Depression

Bail Amounts

Heart Disease

Homelessness

Low incomeSickle Cell

InsuranceRates

Graduation Rates

Asset Accumulation

Sentencing

Voting

LiteracyHIV

Capital PunishmentNutrition

Diabetes

Unemployment

Obesity

Maternal/infantDeaths

Political Office

Criminal Justice

Substance Abuse

Personality Disorders

Cultural CompetenceCultural Competence

Knowledge, information & data from & about individuals & groups

Integrated & Transformed

into

clinical standardsskills

service approachestechniques &

marketing programs

that match the individual’s culture and increase both the quality and appropriateness of health care and health outcomes (Davis, 2003).

Developing a Culturally Developing a Culturally Competent System of CareCompetent System of Care

Multi-dimensional/multi-level processMulti-dimensional/multi-level process System LevelSystem Level Organization LevelOrganization Level Program LevelProgram Level Individual LevelIndividual Level

Who am I ?Who am I ?

Cultural ConsiderationsCultural Considerations

Employment

Community Networks

Geographic

Location

Family/Extended Family

Immigration Status Marital

Status

Military Experience

English Language

ProficiencySpiritual Beliefs

Education

Literacy

Parental Status

Class Income

Economics

Political

Context

Country of Origin

Sexual Orientation

Race

Ethnicity

Language

Cultural + Historical

Knowledge/ExperiencePerceptions of

Physical Qualities

Physical

Abilities

Gender

Age

Primary dimensions influence “who” an individual is.

Secondary dimensions influence an individual’s participation. (adapted from Rasmussen, 1996)

The Lunch DateThe Lunch Date

Cultural Competence:Cultural Competence:IndividualIndividual Level Level

Training and Education (films, festivals, forums, Training and Education (films, festivals, forums, books)books)

Multidimensional, culturally relevant assessmentsMultidimensional, culturally relevant assessments Assessment tools (set-up role playing luncheons)Assessment tools (set-up role playing luncheons) Office Environment (posters, art, magazines, etc.) Office Environment (posters, art, magazines, etc.) Flexible roles and boundariesFlexible roles and boundaries Maintain an Asking StanceMaintain an Asking Stance Awareness of differences in cultural normsAwareness of differences in cultural norms

individualism vs. collectivismindividualism vs. collectivism Role of the community Role of the community Resources of help and healingResources of help and healing

Willingness to relinquish control and foster consumer Willingness to relinquish control and foster consumer directiondirection

Consumer assessment of provider cultural Consumer assessment of provider cultural competencecompetence

Domains in Program Level

Administration Administration

- Human Resources - Human Resources

- Training and Education - Training and Education

- Data collection - Data collection Services- Identifying Current and Services- Identifying Current and

Emerging NeedsEmerging Needs Health Promotion and Prevention Health Promotion and Prevention Defining the Service NeedDefining the Service Need Delivering the Services Delivering the Services

Cultural Competence: Program LevelCultural Competence: Program Level

Access – decentralized, flexible hours, natural Access – decentralized, flexible hours, natural supports, peer mentors, linguistic supports, peer mentors, linguistic competence, competence, program advisory board, formal program advisory board, formal partnershipspartnerships

Meaningful involvement of consumers, community Meaningful involvement of consumers, community members and family membersmembers and family members

Inclusion of family members as preferredInclusion of family members as preferred Holistic ProgrammingHolistic Programming

Beyond symptom reduction!!!!!Beyond symptom reduction!!!!! employment, housing, health, spirituality, purposeemployment, housing, health, spirituality, purpose Family and Consumer Driven in a Strength based Family and Consumer Driven in a Strength based

ApproachApproach Program diversity policies and practicesProgram diversity policies and practices Maintain a comprehensive and up-to-date Maintain a comprehensive and up-to-date

environmental scanenvironmental scan Culture Specific ApproachesCulture Specific Approaches Outcome AssessmentOutcome Assessment

MISSION andVALUE statements

Diversity Assessment, EVALUATION& Demographics

GOALSDEFINED

PLAN to meet GOAL

ACTIONSBased on PLAN

SERVICESReflect ACTIONS

DATA showsThe Results

ANALYSISOf the DATA

}

}

SELF-IMPROVEMENT CYCLE

SOURCE: WWW.CCSI.ORG

CULTURALLY AND LINGUISTICALLY CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES STANDARDS APPROPRIATE SERVICES STANDARDS

[CLAS][CLAS] (DHHS, 2000)(DHHS, 2000)

Culturally Competent CareCulturally Competent Care

Legal Responsibility to Provide Legal Responsibility to Provide Language Assistance ServicesLanguage Assistance Services

Organizational Supports for Organizational Supports for Cultural CompetenceCultural Competence

Cultural Competence: Cultural Competence: Organizational LevelOrganizational Level

Board of Directors & Executive level support & Board of Directors & Executive level support & responsibility responsibility

Organizational Infrastructure/ ResourcesOrganizational Infrastructure/ Resources Monitor utilization & outcomes by diverse communities Monitor utilization & outcomes by diverse communities Organizational & Program cultural competence plans Organizational & Program cultural competence plans Organizational cultural competence assessmentsOrganizational cultural competence assessments Human Resources/ culturally diverse staffingHuman Resources/ culturally diverse staffing Staff development & supervisionStaff development & supervision Connections to community & natural supportsConnections to community & natural supports Service/ Interventions includes Linguistic CompetenceService/ Interventions includes Linguistic Competence

Cultural Competence at the Cultural Competence at the System LevelSystem Level

Monitoring utilization & outcomes by diverse Monitoring utilization & outcomes by diverse communities communities

Cultural competence system assessments Cultural competence system assessments Workforce Development Workforce Development Standard Setting Standard Setting ContractingContracting Policy AlignmentPolicy Alignment Fiscal AlignmentFiscal Alignment Consumer Input & DirectionConsumer Input & Direction Involvement of Grassroots Providers & Natural Involvement of Grassroots Providers & Natural

SupportsSupports

Cultural Competence: Cultural Competence: Future DirectionsFuture Directions

Measure Development and Measure Development and RefinementRefinement

Outcome Research Outcome Research Feedback Loops Feedback Loops Evidence-based for Whom?Evidence-based for Whom?

Contact InformationContact InformationMiriam E. Delphin, Ph.DMiriam E. Delphin, Ph.D..Co-Director, Cultural Competence and Health DisparitiesCo-Director, Cultural Competence and Health DisparitiesResearch and ConsultationResearch and ConsultationYale University Program for Recovery and Community HealthYale University Program for Recovery and Community Health319 Peck Street, Building 6W, Suite 1C319 Peck Street, Building 6W, Suite 1CNew Haven, CT 06513New Haven, CT 06513(203) 764-7587 – phone(203) 764-7587 – phone(203) 764-7595 – fax(203) 764-7595 – faxMiriam.delphin@yale.eduMiriam.delphin@yale.edu

Amie Parikh, MA Amie Parikh, MA Corporate Compliance OfficerCorporate Compliance OfficerMTI Residential Services, Inc. MTI Residential Services, Inc. 476 48476 48thth Street, 4 Street, 4thth Floor FloorBrooklyn, NY 11220Brooklyn, NY 11220646.539.8091 (c)646.539.8091 (c)718.492.1733 ext.112 (w)718.492.1733 ext.112 (w)Amie_Parikh@yahoo.comAmie_Parikh@yahoo.com