Multi- Cultural Competency:
Impact on American Indians In Florida
Melvena Wilson, DrPH, MPH, CHES
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Learning Objectives
At the conclusion of this presentation, participants should be
able to:
Define issues related to cultural competency in public
health practice.
Identify strategies to promote self-awareness about
attitudes, beliefs, biases, and behaviors that may influence
the care you provide & perception of the quality of care
received
Devise strategies to enhance skills toward the provision of
culturally competent care.
Demonstrate the advantages of the adoption of the CLAS
Standards as appropriate in your
agency/department/organization.
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Welcome and Introduction
• Why we are here
• Who’s the speaker
• What ‘s in it for me
• How - We’ll be moving quickly
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Training Objectives
Provide an overview and opportunity to
discuss Cultural and Linguistically
Appropriate Services (CLAS)
Different ethnic group
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FLDOH-OMH Overview
Poor health outcomes for African Americans,
Hispanic Americans, American Indians and Alaska
Natives, Asian Americans, Native Hawaiians, and
Pacific Islanders are apparent when comparing their
health indicators against those of the rest of the U.S.
population.
These populations experience higher rates of
illness and death from health-related conditions
such as heart disease, stroke, specific cancers,
diabetes, HIV/AIDS, asthma, hepatitis B, and
obesity.
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FLDOH-OMH Overview
OMH's primary responsibility is to improve health and healthcare
outcomes for racial and ethnic minority communities by
developing or advancing policies, programs, and practices that
address social, economic, environmental and other factors which
impact health. Further, OMH seeks to eliminate health disparities
as they relate to groups impacted by disability, gender, age,
socio-economic status, mental/behavioral health problems and
sexual orientation.
OMH is committed to culturally and linguistically
competent systems that will ensure the needs of
minority communities are integrated and addressed
within health-related programs across the state.
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Glossary of Terms
CLAS standards –
the collective set of culturally and linguistically
appropriate services (CLAS) mandates,
guidelines, and recommendations issued by the
United States Department of Health and Human
Services Office of Minority Health intended to
inform, guide, and facilitate required and
recommended practices related to culturally and
linguistically appropriate health services
Note: CLAS mandates are current Federal requirements for all recipients of
Federal funds (Standards 4, 5, 6, and 7).
(National Standards for Culturally and Linguistically Appropriate Services in
Health Care Final Report, OMH, 2001).
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Glossary of Terms
cultural and linguistic competence in health - a set of
congruent behaviors, attitudes, and policies that come
together in a system, agency, or among professionals
that enables effective work in cross-cultural situations.
culturally and linguistically appropriate services health care services that are respectful of and
responsive to cultural and linguistic needs (
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What is Culture
Culture is an essential mediator in people's health
status,
Culture crosses age, gender, religion & ethnicity
Includes our language, customs, beliefs &values
Other factors including health status environment,
economics, genetics, previous and current health
status, and psycho-social factors exert considerable
influence on our well-being.
These are the social determinants of health
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Cultural Competency ~ What is that?
Cultural and linguistic competence is a set of congruent
behaviors, attitudes, and policies that come together
in a system, agency, or among professionals that
enables effective work in cross-cultural situations.
'Competence' implies having the capacity to function
effectively as an individual and an organization within the
context of the cultural beliefs, behaviors, and needs
presented by consumers and their communities.
(Adapted from Cross, 1989).
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Cultural Competency ~ What is that?
Cultural competency is central to closing the disparities
gap in health care.
It’s the way patients and doctors can come together
and talk about health concerns without cultural
differences hindering the conversation, but enhancing
it.
Health care services that are respectful of and
responsive to the health beliefs, practices and cultural
and linguistic needs of diverse patients can help bring
about positive health outcomes.
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Culture and language may
influence:
health, healing, and wellness belief systems;
how illness, disease, and their causes are perceived;
the behaviors of patients/consumers who are seeking
health care and their attitudes toward health care
providers;
the delivery of services by the provider who looks at
the world through his or her own limited set of values,
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What is CLAS?
The CLAS standards are primarily directed at health care organizations;
however, individual providers are also encouraged to use the standards
to make their practices more culturally and linguistically accessible. The
principles and activities of culturally and linguistically appropriate
services should be integrated throughout an organization and
undertaken in partnership with the communities being served.
The 14 standards are organized by themes: Culturally Competent Care
(Standards 1-3), Language Access Services (Standards 4-7), and
Organizational Supports for Cultural Competence (Standards 8-14).
Within this framework, there are three types of standards of varying
stringency: mandates, guidelines, and recommendations as follows:
CLAS mandates are current Federal requirements for all recipients of
Federal funds (Standards 4, 5, 6, and 7).
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Did You Know . . .
Providers can influence the level, quantity and
quantity of diagnostic care given
Patients may be non-compliant for several
reasons
Just being of the same ethnicity as your clients
doesn’t automatically make you competent
Mental Health issues can manifest themselves
with physical symptoms
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I’ve had training….
What's the Difference?
Cultural competence emphasizes the idea of
effectively operating in different cultural contexts,
and altering practices to reach different cultural
groups. Cultural knowledge, sensitivity, and
awareness do not include this concept. Although
they imply understanding of cultural similarities and
differences, they do not include action or structural
change.
Cultural Competence, Awareness, and Sensitivity
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The Difference is…
Cultural Awareness: Developing sensitivity and
understanding of diverse groups involving internal changes in
terms of attitudes and values.
Cultural Knowledge: Familiarization with cultural
characteristics, history, values, belief systems, and behaviors
of another ethnic group.
Cultural Skill: A skill set to access an individual’s background
and formulate a culturally relevant treatment plan.
Cultural Sensitivity: Knowing cultural differences and
similarities exist, without assigning them values, ie., better or
worse, right or wrong.
Interpretation: Facilitating oral communication between
individuals who do not speak the same language and may not
share the same culture.
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How can we incorporate this into
our services
Adapting to different cultural beliefs and practices
requires flexibility and a respect for others view points.
Cultural competence means to really listen to the patient,
to find out and learn about the patient's beliefs of health
and illness. To provide culturally appropriate care we
need to know and to understand culturally influenced
health behaviors.
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Application
Why Culturally Competent Care?
Have you ever experienced a situation where you
were unsure about the best way to approach a
someone (a classmate, teacher, coworker) because
of racial or ethnic concerns?
Was there ever a time when language differences
prevented you from effectively communicating with a
patient?
Have you ever stopped to wonder if you were understood
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Implications
Why Culturally Competent Care?
Increasingly diverse racial, ethnic, and socio-cultural
backgrounds of patients, colleagues, and staff may
present challenges to you as you strive to provide
care.
Cultural and language differences may engender
misunderstanding, a lack of compliance, or other
factors that negatively influence clinical situations and
impact patient health outcomes.
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Discussion/Activity
Cultural Differences
in body language and expressions
Sharing of personal information
Work ethic differences across
generations
Miscommunication or Misperceptions
Can be the result of Cultural differences
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Discussion/Activity
Young mother walks into clinic/office with
5 crying children….
What is your first thoughts/reactions?
Write them down
Now what is your experience with a client
like this
WHY do you feel this way?
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Discussion/Activity
Couple walks into your office/clinic
neither speaks English well, but he
speaks broken/limited English
What is your first thoughts/reactions?
Write them down
Now what is your experience with a client
like this
WHY do you feel this way?
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Discussion/Activity
What is your first thoughts/reactions?
Write them down
Now what is your experience with a client
like this
WHY do you feel this way?
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Discussion/Activity
Man walks into your office/clinic he is
dressed in torn, dirty clothes, and doesn’t
make eye contact
What is your first thoughts/reactions?
Write them down
Now what is your experience with a client
like this
WHY do you feel this way?
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Accommodations
It’s about respect:
ADA
LEP
Interpreters
Translators
Health literacy (beyond reading level)
Areas of Concern
Communicating Across Cultures in a Clinical Setting
Understanding Patients' Customs and Beliefs
Client Services for Limited English Proficiency
Cultural Sensitivity for Client Services
Generations at Work: Differing Styles and
Expectations
Building Diverse Teams
Understanding Diversity
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African Americans
Black includes populations from Caribbean (
Jamica, Haiti, etc.)
History in america of forced migration or
slavery ~ Racism
Distrust – Tuskegee Study (1932-1972)
Natural illness (God’s Will)
Dietary habits
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Hispanic
Hispanic (hispano) – literally means “from
Spain”
Latin- includes everyone from Latin America
Different dialects
Origin of birth matters
57% Catholic – use of word sex
Hot and cold properties
Folk healers
Asian American
Many Countries (China, Japan, Thai, India,
etc.)
Country of origin matters
Many dialects
CAM vs Medical model of healing and
causation
Fastest group- increase in FL
American Indian
Descends of “the original peoples” of North
and South America
Many nations or tribes (over 561 federally
recognized)
Proud and self-determined
Tribal sovernity (self government)
Harmony with nature (Supreme creator)
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Religion
Restrictions on holy days and certain time sof
the day
Dietary restrictions (food prep and type)
Mediation and certain procedures
Benefits of prayer and meditation
Birthing rituals
End of life decisions
Body prep; organ donation; burial
Religion/Spirtuality
Don’t assume
Catholic = birth control
Muslim/Islamic = female purity (male doctors)
Jewish = dietary restrictions
Seventh Day Advent = restrictions on a specfic
day of the week; blood products
Other considerations
Sexuality
Homopathic alternatives
Use of ethnic remedies
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What’s the next steps?
Understand language access laws, and national
standards on culturally and linguistically
appropriate services (CLAS) for bilingual staff
and community interpreters
Understand interpreting roles and types and
modes of interpreting
Develop interpreting skills in pre-session
preparation, introductions, tone, positioning,
register, halting the session, note-taking, and
memory
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What’s the next steps?
Understand cultural competence and cultural
constructs, and how and mediate culturally
Respect a code of ethics, have clear roles and
boundaries, and maintain accuracy and
confidentiality
Understand interpreting in health care,
educational and/or human services settings
(training will be specialized to address the
audience’s needs)
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Resources
CDC NPIN
http://www.cdcnpin.org/scripts/population/cult
ure.asp
HRSA Care Action: Mitigating Health
Disparities Through Cultural Competence
National OMH
NOTE: Information presented in this presentation has been compiled from and adapted
from the above websites and resources.
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Contact Information
Dr. Melvena Wilson,
DOH Office of Minority Health
Melvena_Wilson@doh.state.fl.us
850-245-4941
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Culturally Competent Guiding Values
& Principles
Practice & Service Design
Cultural competence is achieved by identifying and
understanding the needs and help-seeking behaviors of
individuals and families.*
Culturally competent organizations design and implement
services that are tailored or matched to the unique needs
of individuals, children, families, organizations and
communities served.*
Practice is driven in service delivery systems by client
preferred choices, not by culturally blind or culturally free
interventions.*
Culturally competent organizations have a service delivery
model that recognizes mental health as an integral and
inseparable aspect of primary health care.
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Culturally Competent Guiding Values
& Principles
Organizational
Systems and organizations must sanction, and in
some cases mandate the incorporation of cultural
knowledge into policy making, infrastructure and
practice.*
Cultural competence embraces the principles of equal
access and non-discriminatory practices in service
delivery.*
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Culturally Competent Guiding Values
& Principles
Community Engagement
Cultural competence involves working in conjunction
with natural, informal support and helping networks
within culturally diverse communities
Communities determine their own needs.
Community members are full partners in decision
making.
Communities should economically benefit from
collaboration.
Community engagement should result in the
reciprocal transfer of knowledge and skills among all
collaborators and partners.
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Culturally Competent Guiding Values
& Principles
Family & Consumers
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.
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Guiding Values and Principles for
Language Access
Services and supports are delivered in the preferred
language and/or mode of delivery of the population
served.
Written materials are translated, adapted, and/or
provided in alternative formats based on the needs and
preferences of the populations served.
Interpretation and translation services comply with all
relevant Federal, state, and local mandates governing
language access.
Consumers are engaged in evaluation of language
access and other communication services to ensure for
quality and satisfaction.
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