tawara d. goode - robert wood johnson medical...

Rutgers, The State University of New Jersey Liberty Plaza, 335 George Street, New Brunswick, NJ 08901

http://rwjms.rutgers.edu/boggscenter p. 732-235-9300 f. 732-235-9330

Tawara D. Goode

Assistant Professor and Director National Center for Cultural Competence Center for Child and Human Development Georgetown University, Washington, DC

Cultural and Linguistic Competence: Supporting Adults with Developmental

Disabilities and Their Families

November 8, 2013 Doubletree Suites, Mt. Laurel, NJ

The attached handouts are provided as part of The Boggs Center’s continuing education and dissemination activities. Please note that these items are reprinted by permission from the National Center for Cultural Competence. If you want to reproduce them, permission must be requested from and approved by the National Center for Cultural Competence.

1

Tawara D. GoodeAssistant Professor & Director, National Center for Cultural Competence

Associate Director, Georgetown University Center for Excellence in Developmental Disabilities

November 8, 2013

CULTURAL AND LINGUISTIC COMPETENCE: Supporting Adults with Developmental Disabilities and their Families

Part 1.

National Center for Cultural Competence

OBJECTIVES

Slide Source: © 2013 - National Center for Cultural Competence

Participants will:

1. define culture and describe culturally defined belief systems about disability.

2. describe a conceptual framework for a cultural competence model and its implications for individuals and organizations, with an emphasis on those supporting individuals with developmental disabilities and their families.

3. define linguistic competence and cite related legal mandates for the provision of services and supports to individuals with disabilities and their families.

4. Apply these frameworks to the design and implementation of services and supports for families of adults with developmental disabilities.

Slide Source:© 2013 - National Center for Cultural Competence

We will follow the experiences of Marisa and Joan, two parents of

adults with developmental disabilities.

Let’s listen to first to Joan.


How do you define culture

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

languagesvalues

beliefs

customs

practicescourtesies

ritualscommunication

roles

relationships

expectedbehaviors

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 ofinteracting

Data Source: Gilbert, J. Goode, T., & Dunne, C., 2007Slide Source:© 2013 ‐ National Center for Cultural Competence

.

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:© 2013 - National Center for Cultural Competence

2

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: 2013 ‐ National Center for Cultural Competence

An Iceberg Concept of Culture

dress age

gender language race or ethnicity

eye behavior facial expressions

body language sense of self

concept of justice value individual vs. group

notions of modesty concept of cleanliness

emotional response patterns rules for social interaction child rearing practices

decision‐making processes approaches to problem solving

perceptions of & beliefs about of mental health, health, illness, disability

patterns of superior and subordinate roles in relation to status by age, gender, class sexual orientation gender identity & expression

and much more…

Adapted by the NCCC

physical characteristics

Slide Source:© 2013 ‐ National Center for Cultural Competence

POINT IN TIME & CONTEXT

IMPORTANCE

Slide Source: 2013 - National Center for Cultural Competence

Multiple Cultural Identities

Race or Ethnicity

Disability

Gender or Gender Identity

Religious or SpiritualAffiliation

Health Care Systems

Mental Health Care Systems

Disability Services & Finance Systems

Secondary & Post‐Secondary

Education Systems

Rehabilitation Systems

Employment Sector

Legal Systems

Advocacy Systems

Housing Systems

Transportation Systems

Community

Family

Individual with a

disability

Socio‐Political Environment

Convergence of Cultural Contexts:

A Focus on Disability


Organization culture is …a pattern of shared basic assumptions that the group learned as it solved its problems of external adaptation and internal integration, that has worked well enough to be considered valid and therefore, to be taught to new members as the correct way to perceive, think, and feel in relation to those problems. (Schein, E., 1985)

Slide Source: National Center for Cultural Competence, 2012

CULTURE IS THE LENS BY WHICH WE VIEW THE WORLD


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CULTURAL AND LINGUISTIC COMPETENCE: Supporting Families of Adults with Developmental Disabilities


Cultural Diversity and

Differing World Views

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.


What are the demographic trends in


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 FactorsHealth & 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


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

4

The Common Cold


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


Cultural Beliefs about Health, Mental Health, Illness, Disease, Disability

Reliance on traditional remedies and healers

Culture bound syndromes

Delaying access to care

Historical mistrust of health care, mental health,education, and social service professionals

Experiences of racism, discrimination, and bias

Cultural and linguistic barriers

Stigma

Cultural Influences on Beliefs and Practices Related to Health, Mental Health, and Related Systems and Providers of Care

T.D. Goode

Slide Source:© 2013 - National Center for Cultural Competence Slide Source:© 2013 - National Center for Cultural Competence


Debates about Cultural Identity: Perspectives on Race, Culture, & Disability


VIEWS ON DISABILITY IDENTITY

The population of people who experience disability is extraordinarilydiverse and, therefore, the idea of a common disability identity isolates disability artificially from intersecting identities related to race, gender, sexuality, class, age, and other axes of social significance. (p.43).


SOURCE: Gill, C. & Cross, W. (2010). Disability Identity and Racial-Cultural Identity Development: Points of Convergence, Divergence and Interplay. In F. Balcazar, Y. Suarez-Balcazar, T. Taylor-Ritzler, & C. Keys (Eds.), Race, Culture, and Disability: Rehabilitation Science and Practice. Sudbury, MA: Jones and Bartlett Publishers

5

RACIAL IDENTITY vs. DISABILITY IDENTITY



There is no simple relationship between race and disability.

Some people of color with disabilities have prioritized their identification and affiliation with persons who share their cultural/racial heritage and have had little contact with disability groups.

They tend to see disability in terms oflimitation rather than identity.(p.46)

RACIAL IDENTITY vs. DISABILITY IDENTITY

Some people of color have substantial contact with disability groups.

They are more likely to identify as being “disabled” and to reference parallels between race and disability.

Some say that their experiences of race-based oppression have prepared them to understand disability as a socialminority experience. This suggests intersectional expressions of identify. (p.46)





NCCC GUIDING VALUES AND PRINCIPLES


Family is defined differently by different cultures.

Family as defined by each culture is usually the primary system of support and preferred intervention.

Family/consumers are the ultimate decision makers for services and supports for their children and/or themselves.

What are the values guiding services and supports that you provide or access?

Data Source: NCCC, retrieved on 10/17/13 from http://nccc.georgetown.edu/foundations/frameworks.html


Let’s further explore and discuss

these conceptual frameworks and apply them to a

vignette.

VIGNETTE


A Latino family sought assistance from a County Community Services Office for their adult daughter who has a developmental disability. The intake team concluded, based on the age of the parents and the need to prepare for future, that the adult daughter would be best served in a community-based, supported living setting as it would foster independence, inclusion, and self-determination. The family did not believe that independence and self-determination were all that important for their daughter, indicating that their daughter would be loved and safe at home with them.

What are the cultural factors presented by this situation? Describe the differing world views and values between the family and

the intake team? How would you approach this situation?

6



CONTACT US

National Center for Cultural Competencehttp://[email protected]

The content of and this PowerPoint presentation are copyrighted and are protected by Georgetown University's copyright policies.

Permission is granted to use this PowerPoint presentation in its entirety and/or individual slides for non-commercial purposes if:

the material is not to be altered and• proper credit is given to the author(s) and to the National Center for Cultural Competence.

Permission is required if the material is to be:• modified in any way • used in broad distribution.

To request permission and for more information, contact [email protected].

10/22/2013

1

Tawara D. GoodeAssistant Professor & Director, National Center for Cultural Competence

Associate Director, Georgetown University Center for Excellence in Developmental Disabilities

November 8, 2013

CULTURAL AND LINGUISTIC COMPETENCE: Supporting Adults with Developmental Disabilities and their Families

Part 2.

National Center for Cultural Competence

OBJECTIVES


Participants will:

1. define culture and describe culturally defined belief systems about disability.

2. describe a conceptual framework for a cultural competence model and its implications for individuals and organizations, with an emphasis on those supporting individuals with developmental disabilities and their families.

3. define linguistic competence and cite related legal mandates for the provision of services and supports to individuals with disabilities and their families.

4. Apply these frameworks to the design and implementation of services and supports for families of adults with developmental disabilities.


Getting on the Same Page:Definition and Conceptual Framework

Cultural Competence

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. GoodeSlide Source:© 2013 - National Center for Cultural Competence

Cultural ResponsivenessCulturally relevant

policies

practices

behaviorsstructures

attitudes

…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 Cross, Bazron, Dennis & Isaacs, 1989.

CULTURAL COMPETENCE


1• value diversity

2• conduct self‐assessment

3• manage the dynamics of difference

4• institutionalize cultural knowledge

5• adapt to diversity (values, polices, structures & services)

Five Elements of Cultural CompetenceORGANIZATIONAL LEVEL

(Cross, Bazron, Dennis and Isaacs, 1989)Slide Source:© 2013 ‐ National Center for Cultural Competence

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Five Elements of Cultural CompetenceINDIVIDUAL LEVEL

acknowledge cultural differences

understand your own culture

engage in self‐assessment

acquire cultural knowledge & skills

view behavior within a cultural context

1

2

3

4

5

(Cross, Bazron, Dennis and Isaacs, 1989)Slide Source:© 2013 ‐ National Center for Cultural Competence

ESSENTIAL ELEMENTS IN ACULTURALLY COMPETENT SYSTEM


policy making

administration

practice & service delivery

patient, family, consumer

community

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

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)

Slide Source:© 2013 - National Center for Cultural CompetenceSlide Source:© 2013 - National Center for Cultural Competence

Guiding Values and Principles for Cultural Competence

Culturally competent organizations and systems design and implement services that are tailored or matched to the unique needs of individuals, children, families, and communities served.

Cultural competence involves working in conjunction with natural, informal support and helping networks within diverse communities.

Retrieved from http://nccc.georgetown.edu/foundations/frameworks.html


Getting on the Same Page:Definition and Conceptual Framework

Linguistic Competence

What are the demographic trends for languages spoken in


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LINGUISTIC COMPETENCE

Policy

Practices

Structures

Procedures

Dedicated Personnel Resources

Dedicated Fiscal

Resources

LINGUISTIC COMPETENCE FRAMEWORK

Data Source: Goode & Jones, Revised 2009, National Center for Cultural Competence

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



What are the legal mandates, guidance, or standards related to linguistic competence and language access?

How is the state of New Jersey addressing these legal requirements?

How is your organization or program addressing these legal requirements?

How do they impact services and supports for adults with developmental disabilities and their families?

Title VI of the Civil Rights Act of 1964-Sec. 601 ensures –nondiscrimination in Federally Assisted programs and states that “No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance”.

– http://www.hhs.gov/ocr/civilrights/resources/laws/index.html

Title VI ‐ Civil Rights Act of 1964SEC. 601 TITLE VI‐‐NONDISCRIMINATION IN FEDERALLY ASSISTED PROGRAMS

Data Source: Civil Rights Act of 1964, P.L. 88‐62Slide Source: © 2013 ‐ National Center for Cultural Competence

Who Does Title VI Protect?


EVERYONE!

Title VI protects persons of all colors, races, and national origins.

Title VI protects against national origin discrimination and are not limited to U.S. citizens.

Title VI states that:“no person shall be discriminated against on the basis of race, color, or national origin. Section 601 and 42 USC 2000d et. Seq.

Provisions related to language access:

Service providers must take reasonable steps to provide meaningful access to their programs by persons with limited English proficiency (LEP). [68 Fed. Reg. 153 at 47322]

Providers that must provide language assistance services in order to comply with Title VI should implement policies and procedures to provide information in appropriate languages and ensure that LEP persons are effectively informed of and have meaningful access to covered programs. [68 Fed. Reg. 153 at 47320]

http://usinfo.state.gov/usa/infousa/laws/majorlaw/civilr19.htm

Title VI – National Origin Discrimination


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Who is Covered Under Title VI?

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

Slide Source: © 2013 National Center for Cultural Competence

Linguistic Competence: LEGAL MANDATES & GUIDANCE


Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination

Affecting Limited English Proficient Persons

http://www.hhs.gov/ocr/civilrights/resources/laws/revisedlep.html

Slide Source:© 2013 National Center for Cultural Competence

Executive Order 13166: Improving Access to Services for Persons with Limited English Proficiency

U.S. Department of Justice

U.S. Department of Education

U.S. Department of Health & Human Services

Cultural and Linguistic Competence: NATIONAL STANDARDS


National Standards on Culturally and Linguistically Appropriate Services in Health and Health Care (CLAS)

https://www.thinkculturalhealth.hhs.gov/

National CLAS Standards:Themes


Characteristics of Culturally and Linguistically Competent

Organizations & Personnel

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5

Philosophy

Mission statement

Policies, Structures, Procedures, Practices

Diverse Knowledgeable Skilled Workforce

Dedicated Resources & Incentives

Community Engagement & Partnerships

Conduct of Research with and for Diverse Communities

Publish and Disseminate

Advocacy (disparities, health equity, social justice)

Characteristics of Culturally and Linguistically Competent Organizations and Systems


Values & principles

Vision & mission

Allocation of fiscal and personnel resources

Quality improvement & program evaluation

MIS, EMR, data collection systems

Contracts and consulting agreements

Conduct of and/or participation in research to decrease disparities (race, ethnicity, languages spoken, SES, geographic locale)

Advocacy with and on behalf of vulnerable, marginalized communities and populations

Culturally & Linguistically Competent PracticesPOLICYMAKING


Source: Tawara D. Goode

Conduct organizational or program self-assessment

Recruit, retain, support a diverse workforce

Ensure a well-trained, competent workforce able of providing services and supports to culturally and linguistically diverse populations

Implement and evaluate modes of service deliver adapted to community and cultural contexts

Ensure the provision of language access services consistent with Title VI other requirements

Allocate fiscal resources and ensure budget line items to support organizational/program capacity

Integrate cultural and linguistic competence into quality improvement

Include knowledge and skill sets in staff/faculty position descriptions and address in performance measures

Culturally & Linguistically Competent PracticesADMINISTRATIVE



intake interview protocols

assessment and diagnostic protocols

treatment/service plans and interventions

medication protocols

education and counseling

information dissemination

communication (based on age, culture, literacy, LEP, English language learners)

Culturally & Linguistically Competent PracticesPRACTITIONER/STAFF


Modify approaches to:


consulting or forming alliances with traditional and indigenous healers and practitioners

consulting or partnering with cultural brokers

establishing relationships with key community informants

pursuing opportunities for coaching and mentoring

participating in educational forums to address the “ISMs”

assuming leadership to address disparities and inequities in health care and behavioral health care

Culturally & Linguistically Competent PracticesPRACTITIONER/STAFF


Consider …


ADVOCACY

PARTNERSHIPS

ADVISORY GROUPS

BOARD MEMBERSHIP

FACULTY, PROFRAM STAFF, CONSULTANTS

KNOWLEDGE BEACON

Culturally & Linguistically Competent PracticesCHILD/YOUTH/FAMILY



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6

As a culturally competent _________I am capable of interacting positively with

people who do NOT

look like,talk like,

think like,believe like,act like,

live like...ME!!!

Source Multnomah County Department of Health.Slide Source: The National Center for Cultural Competence, 2013

move like,

Modification from Mike Magy,Massachusetts Department of Mental Health, November 2005 .

love like...

Taking the next steps

CONTACT US

National Center for Cultural Competencehttp://[email protected]

The content of and this PowerPoint presentation are copyrighted and are protected by Georgetown University's copyright policies.

Permission is granted to use this PowerPoint presentation in its entirety and/or individual slides for non-commercial purposes if:

the material is not to be altered and• proper credit is given to the author(s) and to the National Center for Cultural Competence.

Permission is required if the material is to be:• modified in any way • used in broad distribution.

To request permission and for more information, contact [email protected].

CULTURAL COMPETENCE: WHAT DOES IT MEAN TO ME? FIVE ELEMENTS OF

CULTURAL COMPETENCE THINGS THAT COME EASY FOR ME THINGS THAT ARE DIFFICULT FOR ME

ACKNOWLEDGE

CULTURAL

DIFFERENCES

UNDERSTAND YOUR

OWN CULTURE

ENGAGE IN SELF-ASSESSMENT

ACQUIRE CULTURAL

KNOWLEDGE

VIEW BEHAVIOR IN A

CULTURAL CONTEXT

Developed by the National Center for Cultural Competence, Center for Child and Human Development, Georgetown University 2013

Developed for the Boggs Center Disabilities Lecture Series ◊ Mt. Laurel, N.J. ◊ November 8, 2013 © National Center for Cultural Competence ◊ Center for Child and Human Development ◊Georgetown University

CULTURAL COMPETENCE: WHAT DOES IT MEAN FOR YOUR ORGANIZATION, AGENCY, OR PROGRAM?

FIVE ELEMENTS OF CULTURAL COMPETENCE

RELATE THESE CONCEPTS TO SERVICES AND SUPPORTS YOU PROVIDE OR RECEIVE

VALUE DIVERSITY

CONDUCT SELF‐ASSESSMENT

MANAGE THE

DYNAMICS OF

DIFFERENCE

ACQUIRE &

INSTITUTIONALIZE

CULTURAL

KNOWLEDGE

ADAPT DIVERSITY

TO THE CULTURAL

CONTEXTS OF

COMMUNITIES

SERVED

REFERENCES

Prepared by Tawara D. Goode, MA

Gill, C. & Cross, W. (2010). Disability Identity and Racial‐Cultural Identity Development: Points of Convergence, Divergence and Interplay. In F. Balcazar, Y. Suarez‐Balcazar, T. Taylor‐Ritzler, & C. Keys (Eds.), Race, Culture, and Disability: Rehabilitation Science and Practice. Sudbury, MA: Jones and Bartlett Publishers Goode, T.D. & Like, R.C. (2012). Advancing and sustaining cultural and linguistic competence in the American health system: Challenges, strategies, and lessons learned. In D. Ingle, A. Chiarenza, I. Kotsioni, and W. Devillé (Eds.), Inequalities in Health Care for Migrants and Ethnic Minorities. COST Series on Health and Diversity Volume II, Antwerp: Garant. Goode, T. D. (2010). A guide for using the cultural and linguistic competence assessment for disability organizations. Washington, DC: National Center for Cultural Competence, Georgetown University Center for Child and Human Development. Gilbert, J., Goode, T., & Dunne, C., (2007). Cultural Awareness. Curricula Enhancement Module Series. Washington, DC: National Center for Cultural Competence, Georgetown University Center for Child and Human Development. National Center for Cultural Competence. Foundations of f Cultural and Linguistic Competence. Retrieved on 10/21/13 from http://nccc.georgetown.edu/foundations/index.html Schein, E. H. (1985). Organizational culture and leadership: A dynamic view, by Edgar H. Schein. San Francisco, CA: Jossey‐Bass. U.S. Department of Health and Human Services, Office of Minority Health. National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care. (2013). A Blueprint for Advancing and Sustaining CLAS Policy and Practice. Retrieved on 10/18/13 from https://www.thinkculturalhealth.hhs.gov/ U.S. Department of Homeland Security, Office of Immigration Statistics, U.S. Legal Permanent Residents: 2011 Annual Flow Report, April 2012‐Randal Monger & James Yankay. Table 3‐Flow by Region and Country of Birth, Fiscal Years 2009 to 2011. U.S. Census Bureau, 2010 American Fact Finder, 2011 American Community Survey, Table DP05. U.S. Census Bureau, American Fact Finder, Summary File 1, Table QT‐P4, Race Combinations of Two Races & Not Hispanic or Latino: 2010. U.S. Census Bureau, American FactFinder, 2011 American Community Survey‐ 1 Year Estimates, Table S1601 U.S. Census Bureau, American FactFinder, 2011 American Community Survey‐ 1 Year Estimates, Table S1602 Wehmeyer, M., Abery, B., Zhang, D., Ward, K., Willis, D., Hossain‐Amin, W., Balcazar, F., Ball, A., Calkins, C., Heller, T., Goode, T. Jesien, G., McVeigh, T., Nygren, M., Palmer, S. & Walker, H. “Personal Self‐Determination and Moderating Variables that Impact Efforts to Promote Self‐Determination”. Exceptionality: A Special Education Journal. Vol. 19, Issue, 2011. Taylor Francis Online http://www.tandfonline.com/doi/abs/10.1080/09362835.2011.537225#.UmX9OXDEMgk

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