Cultural Competency Integrating Differences into Community Services.

Cultural Competency

Integrating Differencesinto Community Services

Objectives

Understand Stigma. Understand Culture Competency. Learn Culturally competent care for

people with Mental Health, IDD and Addictions.

Some important definitions

Related to Cultural Competency

StigmaDefinitions from the U. of Chicago PSR Training Manual

“Stigmas are negative attitudes about a group that lead to depriving them ofsome fair opportunities.”

Stereotypesfrom The Asian Health Coalition of Illinois

Stereotypes are exaggerated beliefs or fixed ideas about a person or

group which is held by people and sustained by selective perception and

selective forgetting.

Prejudicefrom The Asian Health Coalition of Illinois

Prejudice is a preconceived idea or negative attitude formed before the facts are known and sustained over generations. A bias without reason,

resisting all evidence…

Discriminationfrom The Asian Health Coalition of Illinois

Discrimination refers to treatment in favor or against a person based on

the group to which that person belongs and not on merit.

People are often stigmatized by:

Mental Illness Intellectual Developmental Disability Physical Disability (including blindness, deafness) Alcoholism /and or Drug Addiction HIV or AIDS, Cancer or other terminal illnesses Criminal behavior Poverty Alternative Lifestyles/sexual orientation Wheelchair bound Gender Obesity

“Different” people are “Stigmatized”

IDD inmates in a sanitorium in Germany

stigmatized groups!All our Consumers belong to

We live in an worldwhich often separates us.

Racism Sexism Ageism Feminism Classism Atheism

Culture from King,et. al

The Office of Special Programs, U.S. Dept. of Education

“The integrated patterns of human behavior that includes thoughts,

communications, actions, customs, beliefs,values, and institutions of racial, ethnic, religious, or social

groups.”

The Bottom Line:People are different, even within

their own culture!

These differences matter when planning and

providing services.

Here at Hill Country MHDDC

Consumers are very diverse in their language and culture.

How Can We Communicate?

Think Language first! Do we need an interpreter? Communicate respectfully. Be sensitive to the consumer and the family. Consider your dress, tone of voice, eye contact,

location, seating arrangement, privacy, etc.

Religion

Religious beliefs shape how the world is viewed. Is illness a punishment? The devil’s work? An

evil spell? Bad karma? For Hispanics, the curandero is a trusted healer. For Lakota Sioux, the ritual Vision Quest,

praying and fasting at a holy site is life changing.

Treatment Issues of Mentally Challenged

People need to have meaningful activity

and purpose in their lives. People need to feel acknowledged and

appreciated. People need safety, structure, and security. Lack of continuity can cause crisis! They may need vocational assistance.

How Do We Best Serve Our Consumers?

Examine own stereotypes.

Build trust.

Use People First language!

How do we best serve our consumers?

Pronounce the person’s name correctly. Get an interpreter, if necessary. Educate yourself from the consumer, his

family, co-workers, etc.

Remember differences do matter!

Cultural Diversity and Health Care

Cultural Competence – Definition

A set of congruent behaviors, practices, attitudes and policies that come together in a system or agency or among professionals, enabling effective work to be done in cross-cultural situations


The Cultural Competence Continuum

Where Am I Now?

Where Could I Be?

The Cultural Competence Continuum


Cultural Competence Definitions 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


Cultural Competence Definitions 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


Acquiring Cultural Competence

Starts with Awareness Grows with Knowledge Enhanced with Specific Skills Polished through Cross-Cultural

Encounters

The Explanatory ModelAuther Klienman, PH.D.

Culturally sensitive approach to asking

inquiring about a health problem

What do you call your problem? What do you think caused your problem? Why do you think it started when it did? What does your sickness do to you? How

does it work? How severe is it? How long do you think you

will have it?(continued next page)

The Explanatory ModelAuther Klienman PH.D.

Culturally sensitive approach to asking about a health problem

What do you fear most about your illness? What are the chief problems your sickness

has caused you? Anyone else with the same problem? What have you done so far to treat your

illness: What treatments do you think you should

receive? What important results do you hope to

receive from the treatment? Who else can help you?

The LEARN ModelBerlin and Fowkes

Listen to the patient’s perception of the problem

Explain your perception of the problem

Acknowledge and discuss differences/similarities

Recommend treatment

Negotiate treatment

Working with Interpreters

Qualifications: Bilingual, bicultural, understands

English medical vocabulary Comfort in the medical setting,

understands significance of the health problem

Preserves confidentiality


Multiple Roles:

Translator of Language

Culture Broker

Patient Advocate: Convey expectations, concerns


Use language to identify the

interpreter as the go-between, not as the person to be blamed, e.g., the interpreter might say, “The doctor has ordered tests and this is what he says”


Translation factors Language: how are new words created?

Navajo: Penicillin = “the strong white medicine shot you get for a cold”

Minimize jargon, e.g., “machine to look at your heart” instead of “EKG”

Nonverbal communication = 60% of all communication

Nodding may indicate politeness, not comprehension

Bilingual interviewing takes at least twice as long as monolingual interviews!

Caretakers’ Responsibilities

Learn and use a few phrases of greeting and introduction in the patient’s native language. This conveys respect and demonstrates your willingness to learn about their culture.

Tell the patient that the interpreter will translate everything that is said, so they must stop after every few sentences.


When speaking or listening, watch the patient, not the interpreter. Add your gestures, etc. while the interpreter is translating your message.

Reinforce verbal interaction with visual aids and materials written in the client’s language.

Repeat important information more than once.

(continued on next page)


Always give the reason or purpose for a treatment or prescription.

Make sure the patient understands by having them explain it themselves.

Ask the interpreter to repeat exactly what was said.

Personal information may be closely guarded and difficult to obtain.

Patient often request or bring a specific interpreter to the clinic.

(continued on next page)


In some cultures it may not be appropriate to suggest making a will for dying patients or patients with terminal illnesses; this is the cultural equivalent of wishing death on a patient.

Avoid saying “you must... Instead teach patients their options and let them decide, e.g., “some people in this situation would...”


It is because we are different that each of us is special.

Putsch III RW. Cross-cultural communication: The special case of interpreters in health care. JAMA 1985;254(23):3344-48

Sockalingum adapted from Hayes, Cultural Competence Continuum, 1993 and Terry Cross Cultural Competency Continuum.

References

What is a TTY

TTY = Text Telephone

Also sometimes called a TDD or Telecommunication Device for the Deaf. A TTY is a special device that lets people who

are deaf, hard of hearing, or speech impaired use the telephone to communicate by typing back and forth instead of talking and listening.

A TTY is required at both ends of the conversation to communicate.

TTY Use

To use a TTY, you set the telephone Handset on to special acoustic cups built into the TTY. Then type the message you want to send on the TTY’S keyboard. As you type, the message is sent over the phone line just like your voice would be sent over the

phone line if you talked. You can read the other person’s response on the TTY’S

text display.

Telecommunications Relay Service

If you don’t have a TTY, you can still call a person who is deaf, hard of hearing, or speech impaired by using the TRS.

With TRS a special operator types whatever you say so that the person you are calling can read your words on their TTY display. When they type a response the TRS operator

will read it aloud for you to hear over the phone.

Cultural Competency Integrating Differences into Community Services.

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