Cultural Competence —Making it Happen: New Mexico PerspectivesCATHY STEVENSON, DIRECTOR

DEVELOPMENTAL DISABIL IT IES SUPPORTS DIVIS ION

NM DEPARTMENT OF HEALTH

Land of Enchantment /Land of Diversity

Land of Enchantment /Land of DiversityDistribution by race and ethnicity compared to US overall

Much smaller proportions of persons who are Black and Asian

Larger proportions of persons who are American Indian and Hispanic.

White, non-Hispanic persons comprised a minority (41.4%) of the state’s population in 2012.

New Mexico’s American Indian population includes part of the Navajo Nation, 19 pueblos, and two Apache tribes.

http://nmhealth.org/publication/view/report/43/

Land of Enchantment /Land of DiversityAmong persons who were born outside the United States, those living in New Mexico are less likely to have received U.S. citizenship, compared with the same population in the U.S. overall.

Compared with the United States, New Mexicans are more likely to speak a language other than English at home (36.3% vs. 20.8%).

New Mexico also had more bilingual households. The proportion of persons who reported speaking some language other than English at home, and also speaking English well was 26.9% in New Mexico compared with 12.1% in the U.S. (Figure 11)

The median income in New Mexico households in 2010–2012 was is $43,518, 84% of the U.S. median household income ($51,771) during the same period.

State of Health in New Mexico 2013: www//nmhealth.org/publication/view/report/160/

Land of Enchantment /Land of Diversity

In 2012

New Mexico was the fifth largest U.S. state in terms of land area, but only the 36th most populous state.

Two-thirds of the residents lived in the six most populous of our 33 counties.

Age distribution

median age of 36.6 years in New Mexico,

compared with 37.2 years in the United States.

Average age of DDW participants is 39 years

A Sense of History and Place is Important

Most of New Mexico’s American Indian tribes have been located on their current lands since before Francisco Vasquez de Coronado arrived in 1541.

Spanish settlers started arriving in 1598, and Santa Fe was settled by the Spanish in 1610 at about the same time the English, French, Dutch and Spanish were claiming colonies on the East and Gulf coasts of the U.S.

It was not until 1848 that the New Mexico territory was ceded to the United States, and in January of 1912, New Mexico became the 47th state of the Union.

Many New Mexico Hispanic families trace their origins to Spanish colonists and still live on land that was granted to their ancestors by the king of Spain.

Setting expectations – Tribal Consultation NM is the only state that has a law requiring formal collaboration with tribes. The State Tribal Collaboration Act, which calls for collaboration and cultural

competence, the training itself reviewed the historical and cultural aspects of all native Americans that currently reside in NM

CMS requirements for HCBS Waivers also lead to State/Tribal Collaboration. Our last DDW renewal included in addition to the required notification:State/Tribal Workgroup

Formal State/Tribal Collaboration Meeting

State Tribal Collaboration Act, NM DOH 2014 Report -http://nmhealth.org/publication/view/report/850/

Setting expectations – Cultural CompetenceThe state of NM offers a variety of training on cultural diversity for its employees◦ One class addresses federal standards for culturally and

linguistically appropriate healthcare

DOH is in the process of creating an additional agency wide training/certification program on cultural competencies specific to DOH communications and functions. All employees will be required to complete this training

Setting Expectations – Involving Stakeholders

Department of Health/Tribal Health Weeks

Participation in Listening Sessions hosted by Advocates (DDPC, Disability Rights, ARC)

Collaboration with NM Disability Coalition (DRNM, NMARC, Gov. Commission on Disability, Independent Living Centers, DDPC)

Collaboration with University Of New Mexico Center for Excellence

Setting Expectations – Involving Stakeholders

Division Stakeholder Policy /Practice Advisory Bodies: Advisory Council on Quality (ACQ) and Interagency Coordinating Council (FIT ICC)

Agency Tribal Liaisons / Active Tribal Consultation

DDSD Office of System Improvement, Constituent Support and Individual Assistance and Advocacy Unit

Developmental Disabilities System Quality Improvement (DDSQI) Interagency Committee

Waiver Redesign and Renewal Project

New Mexico I/DD Services Family Infant Toddler Program (State $$, IDEA and Medicaid): Approximately 13,000 children/families

I/DD State Funded Services: approximately 2000 children and adultsRespite Residential (Independent and Group Home) LivingDay Services (Adult Habilitation and Supported Employment)Autism Services (evaluation, adaptive skill building, family education, respite)Flexible Family SupportMedicaid HCBS Waivers (1915c): approximately 4500 individualsTraditional DD Waiver Mi Vi Self Directed WaiverMedically Fragile WaiverWait List for DD waivers: Approximately 6000

Developmental Disabilities Supports Division Regional Structure • Five Regions• >40% people served

live in the METRO area

• Regional staff help assure understanding of local cultures and needs

Taking Action-DDW HCBS Focusing on the Person (actnewmexico.org)

DD Regulations require Individualized Services consistent with CMS requirements

Supports Intensity Scale for person centered planning

Access Community Together

New Mexico's Department of Health (DOH) is improving the system of services offered to adults with intellectual and developmental disabilities (IDD) who receive services through the Developmental Disabilities Waiver (DDW) program. This series of changes is named "Access Community Together" or "ACT – New Mexico." Adults with IDD get the services and supports they need to live the life they prefer in the community. The DOH is committed to these changes to help ensure that services will be available to people currently served and the those who are waiting.

Taking Action: DDW HCBS Focusing on the Person (actnewmexico.org)

NM Standards, Policies and Mandatory Training supportIndividual Rights/AdvocacyInformed Decision making (e.g. Support through CoC for health care

decisions/plans, forms and processes)Individual vison driven planning in the areas of Employment, Meaningful

Day, Health/Wellness… Positive Behavior SupportParticipatory Approach / Access to Assistive Tech and Adaptive Equipment Translation and interpretations supportStaff with similar cultural/ linguistic backgroundsEnd of Life Planning and Support

Taking Action –Program Design Focused on the Person/Family

MI Via – Self Directed ProgramOriginally cross population program Participants hire an supervise their own staff Participants customize supports to meet their needs

SM 20 - New Flexible Support Pilot – Support for people on the DDW Waiting List

Family Infant Toddler ProgramServices in home or other Natural Environment Staff matched to cultural linguistic preferences of the familyMaterials in English, Spanish and some Native Languages, or alternate formats

Taking Action-Awareness and Ethical Decision Making

*Values In Action Training

Series of workshops across the I/DD system starting with state staff and advisory council members to develop our ability to fully implement values-based decisions.

Encourages dialogue using personal, professional, and organizational values to make ethical decisions when you face difficult choices, alone and with others.

When resources are limited, important values are in tension, and stakeholders may be negatively impacted, you will have a clear road map to guide you to a decision based upon what matters most.

Builds competence and understanding on how to communicate tough choices authentically and credibly to those who deserve to know.

* Ethical Decision Making-Values in Action is a Proprietary Product of Decision Resources, Mark Bennett. Contact: Mark Bennett <mark@decisionres.com>

Taking Action –Acknowledgment and Celebration

NM Shining Stars

Community Inclusion Awards

◦ Community and Heritage events◦ Fiestas

◦ Festivals

◦ Markets

◦ Holidays

Person specific celebrations and events

Taking Action-Shining Stars Portrait ProjectsAn extension of Five Valued Experiences by John

O’Brien and Connie Lyle: Guide the Telling of Lives of Inclusion.

Community Participation; Being Respected;

Valued Social Roles; Sharing Ordinary Places;

Community Presence; Contributing; Competency;

Choosing; Autonomy; Make a Difference;

Support Valued Experiences

For information on the Shining Stars Portrait Project or the Art of Social Change by Beth

Mount, go to www.BethMount.org.

NM Shining Stars ProjectShining Stars is a collaborative community project that builds relationships through the creation and sharing of original artwork that tells the stories of Outstanding New Mexicans with Intellectual and Developmental Disabilities (IDD)

Taking Action-Strategies from a Rural Provider -Life Quest

Through daily interaction, staff recognizes and discovers that an individual has a particular interest in various areas whether it is about “communication (linguistic)”, other cultural experiences and likes such as (music, art, dance, language, food, etc). As staff becomes aware of these, opportunities for these preferences are sought and addressed in the planning of events and daily service provision. Using the ISP, i.e., through the IDT and Meaningful Day process the diverse cultural preferences are also identified and used to make those experiences and opportunities available.Use the Personal/Vocational profile process. It is reported that there are times that this process has outcomes about the individual’s cultural background that are significant to the individual, that were not known prior to using this process.Support individual cultural backgrounds through service delivery apply what you learn above specific to cultural individuality and identity; assignment of a staff to work with an individual who speaks the same preferred language

or Find community events in cultural areas that are important to the individual.

Taking Action –Strategies from an Urban Provider - ARCA

Establishing a firm bottom line of respect and dignity – there is no crossing the line (Director goes to all staff orientations to state this personally)

My Star Assessment drives servicesAsk the person and those who know them well for help.

Capture the person’s history - what's important to person and family

Who is most important to them from a cultural perspective. Gather as much information as you can and honor it

Diverse workforce allows good matches between staff and person - Turn-over is a challenge.

When you become aware of a challenge – be incredibly sensitive and avoid making judgments

Training and modeling are critical

Willingness to acknowledge and address when you get it wrong

Never good enough – don’t stop trying to drive the point forward

How are we doing? How do we know?Review of Provider QA/QI PlansProvider satisfaction surveys

General Event Reports

NCI and NM Independence Survey

Events like the annual Quality Summit

Conversations with Individuals, Families and Communities

Resources / Contacts

Resources / Contacts

Shining Stars Portrait Project or the Art of Social Change by Beth Mount, go to www.BethMount.org.

Ethical Decision Making: Values In Action Contact: Mark Bennett mark@decisionres.com

University of New Mexico: • Center for Development and Disability- http://cdd.unm.edu/ , • Continuum of Care- http://coc.unm.edu/

We Invite You To Take a Learning Journey to New Mexico