Cultural competence pdf
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Transcript of Cultural competence pdf
Speaking of Disparities, did you know that?…
Racial/ethnic groups Have less access to, and availability of, mental health
services Are less likely to receive needed mental health services Often receive poorer quality mental health treatment Are underrepresented in mental health research
African Americans have higher death rates than Whites for 12 of the 15 leading causes of death
Did you also know that?… Hispanic/Latino and African American children
are less likely to receive specialty mental health care as opposed to white children
Suicide is the second leading cause of death for American Indian and Alaska Native youth in the 15-24 age group, 2.5x the national average
82% of youth charged in adult courts are youth from racial/ethnic groups
And… Hispanic/Latina and Asian American female teens
have the highest rates of depression
Children of Color are over-represented in the JJ and Child Welfare systems and for the most part under-represented in the community based mental health system
Reducing disparities for ethnic/racial groups would have saved $229.4 billion in 2003-2006
Eliminating disparities for racial/ethnic groups would have reduced indirect costs associated with illness and premature death by more than $1 trillion between 2003 and 2006
Safe Schools/Healthy Students Strategic Planning for Sustainability
Ken Martinez, Psy.D.Technical Assistance PartnershipAmerican Institutes for Research
Washington, D.C. / Corrales, New MexicoMay 18-19, 2011
The Color of Americais Changing Even More in 2011_____________ White (Non-Hispanic) 196.8 million 63.7% + 1% Latino/Hispanic 50.5 million 16.0% +43% African American 38.9 million 12.6% +12% Asian American 14.6 million 4.8% +43% American Indian/
Alaska Native 2.9 million .9% +18.4 Native Hawaiian
and other Pacific Islander .5 million .2% +35.4
Other race 19.1 million 6.2% +24.4 Bi/Multi-racial 9.0 million 2.9%__ +32.0_
People of Color >135.4 million/308.7 43%(Not counting all other ethnic groups) (US Census Bureau, 2011)
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7Ken Martinez, Psy.D.
Projected Rate of Increase of Youth of Color in US from 1995-2015
American Indian/Alaska Native +17% African American +19% Hispanic/Latino +59% Asian American, Native Hawaiian
and other Pacific Islanders +74% Caucasian/White - 3%
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What is Cultural and Linguistic Competence (CLC)?
Cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or amongst professionals and enables that system, agency, or those professionals to work effectively in cross-cultural situations. (Cross, et al., 1989)
It is about “respect” and ultimately, about eliminating disparities and disproportionalities
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Examples of what CLC is… Vision, mission, logic modeling,
and strategic planning that is aligned and reflects commitment & action to CLC values, practices and outcomes at all levels -
A safe organizational climate based on trust and mutual respect
Individual and organizational self-assessment which leads to individual and organizational change that addresses challenges
Sufficient resources (human and financial) to reflect the leadership’s commitment to infuse CLC into practice and sustain it over time
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Examples of what CLC is… Administration, management
and staff mirroring the population(s) served proportionately – Adult role modeling/Practicing what we preach
Policies and procedures that operationalize CLC in daily work (organizational structure, planning, design, budgeting, P&P, implementation, evaluation)
Contracts with providers, agencies, community partners, etc. that include specific contractual expectations about CLC with incentives/penalties
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Examples of what CLC is… Administrative and staff performance appraisals that include
CLC performance measures that are directly linked to salary increases and promotions
A receptive organizational environment that promotes addressing race, ethnicity, class, disability, privilege, power, gender, sexual orientation, historical trauma, spirituality and other psychosociocultural issues relevant to the school, community and staff
A CQI process (productive use of data) that is directed to eliminating disparities in access, availability, quality and outcomes for un-served/underserved student populations
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Examples of what CLC is not…
A “color-blind” philosophy and approach An “add on” or “overlay” or “just another
(unfunded) government requirement” Limited to ethnic/racial groups Just a translated brochure Just literature with faces of children of
different colors Just serving ethnic food or playing ethnic
music in class or at trainings/gatherings
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Examples of what CLC is not… Choosing a youth of color to make a
presentation because s/he is a youth of color Asking a receptionist or maintenance worker
to interpret Having a person of color on an advisory
board as the token representative of the diverse community
Assuming that a staff member of color is culturally or linguistically competent –stereotyping and unfairly placing burden on him/her
Assigning all work associated with CLC to one individual – relieving everyone else of ownership, reducing likelihood of system infusion which undermines sustainability
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Examples of what CLC is not… Collecting demographics on
ethnic/racial populations and not using the data to address and eliminate disparities – cost and burden vs. value
Stereotyping individuals because they belong to an ethnic/racial group, lower SES group or underserved population (LGBTQI2-S), based upon our limited and sometimes incorrect knowledge of that group
Ignoring “youth culture” “Western benevolence” – we know what
is best for you! (cultural deprivation/ disadvantaged model)
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Besides Doing the “Right Thing”
What is the Ultimate Goal of Cultural and Linguistic
Competence?….
Eliminating/Reducing Disparities Eliminating/Reducing
Disproportionalities Improving access, availability,
quality/appropriateness, accountability, affordability, utilization and outcomes
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Disproportionality refers to a situation in which a particular racial/ethnic group of children is represented in child welfare, juvenile justice, mental health or other child serving systems at a higher percentage than other racial/ethnic groups and the general population. Over/Under-representation - the difference between how
children/ youth are represented
Disparity refers to disparate or inequitable treatment (how the individual is treated) or services (types, access, availability, utilization, affordability, quality, appropriateness, quantity) provided to children/youth from ethnic/racial groups and their outcomes as compared to those provided to similarly situated White children/youth.
Adapted from Race Matters Consortium, 2001
Definitions
Institutional○ Laws, policies and practices○ Structural/Institutional racism
Social Determinants○ Socio-economics, education, employment, housing,
transportation○ Geography / physical environments○ Biology○ Access to/availability/affordability/utilization/quality of services ○ Individual discrimination/prejudice by race, gender, or class ○ Social or environmental stressors / support○ Court/agency culture
Cultural Differences○ World view○ Historical trauma - issues of trust○ Health/wellness/illness/curative beliefs○ Language, values, beliefs, traditions, practices and rituals
Causes of Disparities
Disparities and Disproportionalities of Children of Color “Do your homework” - learn about what
D & D exists in your schools/communities Over-representation in juvenile justice/
child welfare/special education Under-representation in prevention
activities, mentoring programs and community based services/supports
Develop strategies to reduce/ eliminate/increase accordingly
That is all great, but HOW do we do this?Ken Martinez, Psy.D. 20
Data, Data, Data…Did I say Data?
If you don’t identify it, it won’t get counted
If you don’t count it, it won’t get measured
If you don’t measure it, it won’t be in the budget
If it isn’t in the budget, nothing will happen!Ken Martinez, Psy.D. 21
Steps to Gathering and Using Data Get baseline data – collect only what you need
Value vs. Burden Use available Federal, state, county, local, agency sources Begin with census data and projections, American
Community Survey http://www.census.gov/acs/www/
General data points to review Ethnicity, race, income, language preferences/ spoken,
length of residency, acculturation, generation in US Agency data to review
Ethnic/racial percentage/proportion at various points in the systems (child welfare, juvenile justice, special education, other)
“Mine the data” – Dig deeper
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Systems Data from Juvenile Justice -Proportionately by Race/Ethnicity Type of alleged offense Time of alleged offense Location of alleged offense Rates of arrest Rates of, and lengths of stay in, detention/long-
term placement Type of prosecutorial and judicial decisions at
disposition Diversion rates Alternative service rates Availability/quality of services/supports in lock-up
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Systems Data from Mental Health -Proportionately by Race/Ethnicity Rates of inpatient/residential care Rates of outpatient/community based
care Rates of preventive activities/programs Rates of access, availability, utilization,
affordability, appropriateness, quality and outcomes of services/supports
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Systems Data from Schools –Proportionately by Race/Ethnicity Rates of expulsions Rates and lengths of in/out of school detention Rates and lengths of suspensions Reasons for expulsions/suspensions/detentions Rates of special education placements by type Rates of gifted program placements Rates of IEPs Rates of referrals for mental health/substance
abuse services/supports Rates of referrals to police/juvenile authorities
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Steps to Gathering and Using Data Develop community needs
assessment to specifically identify individual/community needs through an inclusive participatory action research process
Attempt to Set up data systems uniformly across
agencies Collect data uniformly for comparison
purposes Set up data systems to be able to
disaggregate/stratify data Mine the data (again)
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Community Example A case of disproportionalities – Special Ed and JJ Used data to track every referral – to deal with the
elephant(s) in the room Analyzed demographics Student Climate Survey and clinical data
Outcomes Parent Advisory Board Parent University Student Advisory Committee Staff development/training Study sessions Family involvement is crucial Engagement of all partners “authentically” Mined the data – dug deeper, disaggregated/stratified data Continuous quality improvement processes
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What does this have to do with me?
Engage all partners authentically It is all about the community and what it needs If you don’t ask the hard questions (confront the
elephant), no significant change will happen Data driven planning and implementation
promotes sustainability Don’t be satisfied with just what you see, dig
deeper Focusing on one or more of the disparities or
disproportionalities can make a significant contribution to community
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How do we become good stewards in our communities and focus on sustainability?
Leadership with vision Political will Commitment and resolve Shared ownership Dedicated resources Meaningful and authentic
partnership and collaboration with community
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How do we become good stewards in our communities and focus on sustainability?
Collecting and using data smartly and strategically – dig deeper again
CQI process directed at eliminating disparities and addressing domains
Accountability to our community
Training/technical assistance
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Safe Schools/Healthy Students What have you done to promote and
infuse CLC by eliminating/ reducing disparities/ disproportionalities in your communities?
Are you using data wisely (addressing the elephants in your room)?
What are your outcomes?
What are your challenges?
How have you met those challenges?
What do you need to succeed and sustain?
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Muchas Gracias
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References
Cross, T., Bazron, B., Dennis, K., and Isaacs, M. Toward a Culturally Competent System of Care, Volume 1. Washington, D.C.: Georgetown University. (1989.)
U.S. Census Bureau http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf
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