Providing Culturally Competent Services for Hard-to-Reach ... · NAPCA serves AAPI elders through...
Transcript of Providing Culturally Competent Services for Hard-to-Reach ... · NAPCA serves AAPI elders through...
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Providing Culturally Competent Services for Hard-to-Reach AAPI Older Adult Consumers
Ashley Muraoka-Mamaclay, MURP Director of Outreach and Education [email protected]
Wesley Lum, PhD, MPH President and CEO [email protected]
NASUAD HCBS Conference | Washington, D.C. August 30, 2016
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National Asian Pacific Center on Aging
Our Mission NAPCA’s mission is to preserve and promote the dignity, well-being, and quality of life of Asian Americans and Pacific Islanders (AAPIs) as they age.
Our Vision A society in which all AAPIs age with dignity and well-being.
www.napca.org
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NAPCA serves AAPI elders through various programs and initiatives
• Senior Community Service Employment Program (SCSEP)
• Senior Environment Employment (SEE)
• Agriculture Conservation Experienced Services (ACES)
• National toll-free multilingual Helpline
• AAPI Aging National Resource Center
• AAPI SMP/SHIP Technical Assistance Project
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Session Overview
• Overview of AAPI Trends and Needs
• Definitions
• Why Prioritize Cultural and Linguistic Competence?
• Organizational Strategies
▫ 4 Best Practices to Implement AAPI Cultural Competency within your Organization
• Community Strategies
• Individual Strategies
▫ Communication and Engagement
▫ Civic Engagement
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Overview of Asian American and Pacific Islander Trends
Defining Asian Americans and Pacific Islanders
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Asian Americans and Pacific Islanders
• A person with origins in any of the peoples of the Far East, Southeast Asia, Indian subcontinent or Pacific Islands.
• The most diverse group
of any other minority group. • Over 30 countries and
speak over 100 languages.
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Total Population Percent
California 5.3 Mil Hawaii 48.0%
New York 1.5 Mil California 13.9%
Texas 1.1 Mil New Jersey 8.8%
New Jersey .78 Mil Nevada 8.1%
Hawaii .67 Mil Washington 8.1%
Illinois .63 Mil New York 7.8%
Washington .56 Mil Alaska 6.7%
Florida .50 Mil Virginia 5.9%
Virginia .48 Mil Maryland 5.9%
Massachusetts .38 Mil Massachusetts 5.8%
Geographic Distribution Among the AAPI Population
(United States Census, 2016. Retrieved from http://factfinder.census.gov/)
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AAPI Older Adults National Demographics
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Growth of 60+ AAPI
• Compared to other races, AAPI older population increased significantly.
• The Growth of 60+ from 2000 to 2010 ▫ Asian American: 76% ▫ Native Hawaiian/Pacific Islander: 60% ▫ Black American: 30% ▫ Hispanic American: 65% ▫ Non-Hispanic White American: 19%
• Between 2010 and 2030, the AAPI older adult population are projected to increase by 145%
(U.S. Census Bureau data, 2000 and 2010 Census)
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AAPI Population Density of 60+ (2006)
Adapted from “Profile of State OAA Programs”, by the Administration for Community Living, Aging Integrated Databases. Retrieved from http://www.agid.acl.gov/StateProfiles/Profile/Pre/?id=41&topic=1&years=2006,2013
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AAPI Population Density of 60+ (2013)
Adapted from “Profile of State OAA Programs”, by the Administration for Community Living, Aging Integrated Databases. Retrieved from http://www.agid.acl.gov/StateProfiles/Profile/Pre/?id=41&topic=1&years=2006,2013
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Geographic Distribution of AAPI 60+ Growth Rate
Top States (# Persons) Top States (Percent)
California 328k North Dakota 116%
New York 83k Montana 102%
Texas 63k South Dakota 90%
New Jersey 44k Vermont 88%
Florida 40k North Carolina 87%
Illinois 37k Tennessee 86%
Washington 33k Georgia 83%
Hawaii 29k Florida 82%
Virginia 27k Wyoming 81%
Maryland 20k Indiana 80%
Georgia 20k Texas 80% Adapted from “Profile of State OAA Programs”, by the Administration for Community Living, Aging Integrated Databases. Retrieved from http://www.agid.acl.gov/StateProfiles/Profile/Pre/?id=41&topic=1&years=2006,2013
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AAPI Needs & Vulnerabilities
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Limited English Proficient AAPI
• Individuals who do not speak English as their primary language and who have a limited ability to read, write, speak or understand English, may be limited English proficient (U.S. Census, 2016)
• A person’s self-assessed ability to speak English less than “Very Well”.
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Limited English Proficiency (LEP) of Older Adults (65+)
8.0
7%
2.4
5%
2.9
4%
57.7
5%
15.4
4%
59
.58
%
24.7
6%
47%
78
%
10
0%
61
%
91
%
75
%
74
%
47%
27%
90
%
61
%
25%
78
%
87
%
64
%
71
%
74
%
33%
40%
3%
66
%
25%
61
%
50
%
24%
75
%
62
%
8%
83
%
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(United States Census, 2016. Retrieved from http://factfinder.census.gov/)
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Immigration – Foreign Born Percentages 13.3
%
3.9
%
9.1
%
35.0
%
6.1
%
66
.5%
20.8
%
70
.9%
73
.8%
86
.7%
58
.4%
69
.6%
65
.6%
6.9
%
38.9
%
76
.1%
41.5
%
71
.9%
58
.5%
33.1
%
3.1
%
87
.5%
67
.2%
10.8
%
69
.4%
75
.9%
67
.9%
(United States Census, 2016. Retrieved from http://factfinder.census.gov/)
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Health Disparities
• Breast cancer ▫ Outweighs heart disease as the leading cause of death for AAPI women
• Lung/Bronchial cancer ▫ Leading cause of death of Asian American men
• Colorectal cancer ▫ Lowest rates of colorectal cancer screening in Vietnamese Americans.
• Hepatitis C & Liver cancer ▫ 50% of the individuals afflicted with chronic Hepatitis B are AAPI
80% of Hepatitis B cases result in liver cancer
• Diabetes ▫ AAPIs who are overweight are at an increased risk
Filipino and Japanese Americans are twice as likely to have diabetes. Native Hawaiians are four times as likely to have diabetes – three times
more for women than men.
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Barriers to Accessing Services
• Limited English Proficiency • Cultural beliefs influencing help-seeking
behavior • Historical or Immigration trauma (ie. Fear or
untrustworthy of Government) • Lack of accessible and available information • Lack of transportation
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Key Definitions
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Includes a range of factors such as ethnicity, language, religion, gender identity, sexual orientation, geography, and other sociological characteristics.
Culture
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Cultural Awareness is achieved by being cognizant, observant, and conscious of similarities and differences among cultural groups, and understanding that one’s culture may influence values, beliefs, judgements and decisions. A commitment to cultural awareness leads to an individual, community, program, or organization to becoming Culturally Competent.
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Person-Centeredness involves perceiving and evaluating interventions from an individual’s perspective, adapting interventions to meet the needs and expectations of those individuals.
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Why Prioritize Cultural Competency?
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Why Prioritize AAPI Cultural and Linguistic Competency?
• Increasing diversity • Establishing partnerships and relationships
with AAPI communities • Improved client health outcomes/ service
equity • Increase in client satisfaction
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Why Prioritize AAPI Cultural and Linguistic Competency? (cont.)
• Increasing staff competence and confidence
• Efficient spending/ resource allocation
• Stronger organizational viability for grants and contracts
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Why Prioritize AAPI Cultural and Linguistic Competency? (cont.)
• Protecting your organization from liability
• Meeting state and federal requirements
▫ Title VI of the Civil Rights Act of 1964
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Organization Strategies to Achieve AAPI Cultural Competency
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4 Best Practices to Achieving AAPI Cultural Competency
(1) Value AAPI diversity;
(2) Assess your organization;
(3) Manage the dynamics of difference; and
(4) Acquire and institutionalize AAPI cultural knowledge.
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• Identify areas for improvement within your organization’s operations to promote racially equitable results for AAPI older adults.
• Foster a multicultural work environment
Best Practice #1: VALUE AAPI DIVERSITY
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• Develop an internal team to guide the ongoing work of removing barriers to opportunity for AAPI older adults, including cultural and linguistic disparities
• Conduct regular organizational assessments.
Best Practice #2: ASSESS YOUR ORGANIZATION
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Best Practice #3: MANAGE THE DYNAMICS OF DIFFERENCE • Implement a mechanism AAPI older adults and their
families to address complaints about barriers to opportunity and racial inequities
• Solicit the input of AAPI staff in organizational planning to ensure AAPI older adults have equitable access to appropriate services.
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Best Practice #4: ACQUIRE AND INSTITUTIONALIZE AAPI CULTURAL KNOWLEDGE
• Identify opportunities for the organization (and staff) to better understand and eliminate racial inequities.
▫ EXAMPLES: AAPI trainings, collaborations with AAPI communities, involvement in government initiatives and planning to reduce inequities
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Strategies to Engage the AAPI Community
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Community Needs Assessment with AAPI Older Adults
• Integrate AAPI populations into organizational planning
• Develop a Communication and Language Assistance Plan
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Partnerships with AAPI- Serving Community Based Organizations
• Relationship building
• Explore the shared benefits of partnership
▫ Consider using dispersed site management strategies (similar to AmeriCorps* VISTA) to address the needs of rural organizations.
▫ Offer to partner on public awareness meetings/ community events.
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Best Practice Example #1
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Best Practice Example #2
https://www.youtube.com/watch?v=f71-b8jggoA
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Strategies to Engage the Individual
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• Use a person-centered approach • Be aware of stereotypes!
Communication and Engagement Strategies
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How Culture Impacts AAPI Communication and Engagement
• AAPI older adults may:
▫ Be reluctant to complain or ask for clarification
▫ Value group consensus more so than other families.
▫ Prioritize family harmony, and fear “family shame”
▫ Vary in level of acculturation
▫ Be impacted by historical trauma
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• Build trust by prioritizing culture! ▫ Ask questions ▫ Mobilize a family’s cultural strengths ▫ Build rapport with family leaders ▫ Utilize cultural reframing techniques
• Establish the professional’s role and assume authority
• Self-disclosure to build social/ cultural connection
Communication and Engagement Strategies (cont.)
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• Be flexible to both native and Western interventions, and collaborate with community partners when appropriate.
▫ BEST PRACTICE EXAMPLE: Ho’oponopono with Native Hawaiians
Ho’oponopono
Communication and Engagement Strategies (cont.)
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• Tips to help comprehension:
▫ Notify LEP AAPI clients of availability of in-language services.
▫ Use open-ended questions.
▫ Provide clear and full information.
▫ Be attentive to non-verbal cues.
▫ Be patient, and consider periods of silence opportunities for reflection on what has been said.
▫ Check for understanding regularly.
Communication and Engagement Strategies (cont.)
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• Formal volunteering vs. informal volunteering
• Generativity • Person-centered
approach ▫ BEST PRACTICE
EXAMPLES: Wah Luck House, White House Conference on Aging
Communication and Engagement Strategies (cont.)
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• Empowerment approach
• Seek family investment into volunteering benefits
• Value assets (e.g. linguistic abilities)
• Collaborate with trusted AAPI- serving CBOs to outreach and train volunteers
Communication and Engagement Strategies (cont.)
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• Consider incentives that may attract some AAPI older adults to volunteering, such as:
▫ Educational programs
▫ Personal request from trusted professional
▫ Stipends/ free meals
▫ Volunteer recognition
Integrate volunteer motivational factors into needs assessments!
Civic Engagement Strategies (cont.)
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Conclusion Almost done!
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Key Takeaways: Organizational Strategies
• To implement AAPI cultural competency within your organization:
1. Value AAPI diversity,
2. Assess your organization,
3. Manage the dynamics of difference, and
4. Acquire and institutionalize AAPI cultural knowledge.
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• Strengthen your relationships/ work with the AAPI community through:
1. Community-based planning
2. Developing partnerships with AAPI- serving community-based organizations and AAPI community leaders
Key Takeaways: Community Strategies
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• Person-centered approach
• Build trust by prioritizing culture!
• Be flexible to both native and western interventions
• Involve family when appropriate
• Increase engagement through partnerships with AAPI- serving community-based organizations
Key Takeaways: Individual Strategies
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How else can NAPCA help?
• Provide your agency and partners with technical assistance on how to better serve the AAPI in your service area.
• Assist in developing a plan that works for
you, taking into consideration the time and resources you have.
• A number of Resources on our website
www.napca.org. ▫ Something missing, just contact us and we can
work on finding that information for YOU!
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AAPI Aging National Resource Center
• NAPCA is developing a National Resource Center on AAPI Aging for the Aging Network.
• Incorporate AAPI specific resources on
four issue areas: ▫ Long Term Services and Supports ▫ Elder Justice ▫ Caregiving ▫ Alzheimer’s Disease and Related Dementias
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QUESTIONS?
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What’s to Come??
• Upcoming Partnerships: ▫ NASUAD IQ
Asian American and Pacific Islander (AAPI) Cultural Competency Course
▫ N4A Cultural Competency Trainings
Introduction to Asian American and Pacific Islander (AAPI) Aging ▫ November 30, 2016 at 3:00pm EST
Asian American and Pacific Islander (AAPI) Families: Integrating AAPI Culture into Practice ▫ December 14, 2016 at 3:00pm EST
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Fa'afetai
Mālō
Mahalo
THANK YOU!
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Contact Information
Wesley Lum PhD, MPH President and CEO [email protected] Ashley Muraoka-Mamaclay MURP Director of Outreach and Education [email protected]
Please feel free to contact us if you have questions!