West Virginia Department of Health and Human Resources
Bureau for Behavioral Health and Health Facilities
Behavioral Health is Essential to Health
Prevention Works
Treatment is Effective
People Recover
Improving the quality of life for West Virginians with behavioral health needs
Funded by:
This training is funded by a grant from the U.S. Department of Health
and Human Services, Substance Abuse and Mental Health Services
Administration, Center for Substance Abuse Prevention, and the
West Virginia Department of Health and Human Resources,
Bureau for Behavioral Health and Health Facilities.
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Participants will become familiar with terminology
related to cultural competence.
Participants will learn the hallmarks of a culturally
competent individual and organization.
Participants will become familiar with tools for
assessing individual and organizational cultural
competence.
Participants will understand the relationship
between culture and substance use risk.
Participants will learn guiding principles for
developing or selecting materials and interventions.
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Integrated pattern of human behavior that
includes thoughts, communications,
languages, practices, beliefs, values,
customs, courtesies, rituals, manners of
interacting, roles, relationships and expected
behaviors of a racial, ethnic, religious or social
group.
Source: http://www.nccccurricula.info/glossary.html
Population in WV (2012 estimate)
White
Black
American Indian/Alaska Native
Asian
Native Hawaiian/Other Pacific Islander
Persons reporting two or more races
Persons of Hispanic or Latino Origin
Foreign born persons, 2007-2011
Veterans, 2007-2011
Same-sex couples per 1,000 households
1,855,413
94.1%
3.5%
0.2%
0.7%
0.2%
1.4%
1.3%
1.3%
166,372
3.7
WV Population: 1.8 million
94.1% White
1.3% Hispanic / Latino
3.5% Black
0.7% Asian
0.4% Other
1.4% 2 or more races
1.3%
Foreign
Born
Culture is more than just race and ethnicity!
Same sex couples:
9.2% Veteran
3.7 per 1,000
households
Appalachian Culture: 4 Distinct Groups
-Descendants of the original settlers of the region
-Hard working coal miner, logger, or factory worker
-Professional group who have moved due to their profession
-Returning Appalachians, individuals who grew up, moved away
for employment, and are now returning.
(Appalachian Regional Commission)
18.9%
Disabled
(Cognitive,
Hearing, Vision,
and Ambulatory)
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Exercise
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Differences in…
 Race
 Ethnicity
 Language
 Nationality or
 Religion
…Among groups within a community,
organization, or nation.
Source:http://www.ncsacw.samhsa.gov/files/TrainingPackage/MOD2/NationalClearingHouseT
echnicalAssistanceBulletin.pdf
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Being cognizant, observant and conscious of
similarities and differences among cultural
groups.
Source: http://www.nccccurricula.info/glossary.html
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A set of values, behaviors, attitudes, and
practices within a system, organization,
program or among individuals and which
enables them to work effectively cross
culturally. Further, it refers to the ability to
honor and respect the beliefs, language,
interpersonal styles and behaviors of
individuals and families receiving services, as
well as staff who are providing such services.
(Denboba, 1993)
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Value diversity and similarities among all
peoples
Understand and effectively respond to
cultural differences
Engage in cultural self-assessment at the
institutional and organizational levels
Make adaptations to the delivery of services
and enabling supports
Institutionalize cultural knowledge
(Denboba, 1993)
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Valuing Diversity
Awareness of the “Dynamic of Difference”
Attitude
Ability to Institutionalize Cultural Knowledge
Practice
Adaptation to Diversity
Cultural Self-Assessment
Source: http://captus.samhsa.gov/access-resources/elements-culturally-competent-prevention-system
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Organizational Values
Governance
Planning and Monitoring/Evaluation
Communication
Staff Development
Organizational Infrastructure
Services/Interventions
Source: http://captus.samhsa.gov/access-resources/ensuring-cultural-competence-organizational-level
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Work with the community
Use a culturally-competent evaluator
Ensure a mechanism for collecting cultural competencerelated information/data
Gain community approval for data collection methods and
analysis
Ensure data is culturally-responsive and appropriate
Create process for identifying culturally-relevant risk and
protective factors and other underlying conditions
Formulate culturally-based assumptions of change
 Identify change from a community perspective
 Gain community approval of product
Source: http://captus.samhsa.gov/access-resources/infusing-cultural-competence-spf
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Examine community resources and readiness
Provide a safe and supportive environment for all
participants
Examine breadth and depth of cultural competence
Check cultural representation (e.g., language, gender, age)
Develop policies (i.e., recruitment and retention, training,
communication and community input) to improve cultural
competence
Ensure that tools and technology are culturally competent
Identify and mobilize mutually acceptable goals and
objectives
Source: http://captus.samhsa.gov/access-resources/infusing-cultural-competence-spf
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Make sure community is represented in the
process
When selecting programs and strategies,
consider their fit with:
 Community culture
 Existing prevention efforts
 Past history
Source: http://captus.samhsa.gov/access-resources/infusing-cultural-competence-spf
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Involve community in the implementation of
strategic plan
Create a feedback loop for communicating
efforts and successes
Source: http://captus.samhsa.gov/access-resources/infusing-cultural-competence-spf
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Make sure the community is represented in
the evaluation process
Ensure that data collection tools reflect
community culture
Use a culturally-competent evaluator
Source: http://captus.samhsa.gov/access-resources/infusing-cultural-competence-spf
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Assessing Epidemiological Data
Assessing Resources
Assessing Readiness
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Are sub-populations experiencing different
consequences?
Do sub-populations exhibit different
consumption patterns?
What is the magnitude—versus impact—of
the problem in particular sub-populations?
Source: http://captus.samhsa.gov/access-resources/needs-assessment-and-cultural-competence-questionsask
What resources are available to or utilized by diverse
populations?
 Does coalition membership reflect the cultures present in
the community?
 Are existing prevention programs offered to the
community's sub-populations? Are these programs culturally
relevant? Are they offered by culturally-competent staff?
 To what extent do stakeholders from across the diverse
community participate in planning activities?
 Do culturally-competent organizations exist that can deliver
the necessary services?
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Source: http://captus.samhsa.gov/access-resources/needs-assessment-and-cultural-competence-questionsask
What tools does the community currently use to
assess readiness? Are these appropriate for diverse
communities?
 Has anyone assessed readiness levels within diverse
communities? If so, how do they vary across
communities?
 Is your “priority problem” viewed differently
within/across racial or ethnic communities?
 If so, what types of cultural differences might explain
why your priority problem is viewed differently across
racial or ethnic groups?
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Center for Substance Abuse Prevention, 2009
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Is the intervention appropriate for the population identified in
the community needs assessment and community logic model?
Has the intervention been implemented successfully with the
same or a similar population?
Are the population differences likely to compromise the results?
Is the intervention culturally appropriate? Did members of the
culturally identified group participate in developing it?
Were intervention materials adapted to the culturally identified
group?
Is the intervention culturally feasible, given the values of the
community?
(Center for Substance Abuse Prevention, 2009)
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Activity: Which One Works?
Source: Bronheim, S., & Sockalingam, S. (2003). A guide to: Choosing and adapting culturally and
linguistically competent health materials. National Center for Cultural Competence, Retrieved from
http://www11.georgetown.edu/research/gucchd/nccc/documents/Materials_Guide.pdf
Potential partners:
 Individuals/families affected by the issue
 Elders in the community
 Leaders in the faith/spiritual community
 Politicians that represent the community
 Health care professionals and institutions that serve the
community
 Community-based health and social service agencies
 Community-based service, advocacy or social organizations
 Local/ethnic media
 Community businesses
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Center for Substance Abuse Prevention, 2009
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Identify the following:
Culturally based beliefs, values and attitudes
influencing the behavior
Lines of authority
Caretaking roles
Health decision-makers
Center for Substance Abuse Prevention, 2009
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Identify culturally related motivations for changing
behaviors. These motivators may include:
 Living longer
 Improving health in the community
 Having better health
 Pleasing authority figures
 Being more economically successful
 Being better-liked or more popular, or
 Becoming assimilated
Center for Substance Abuse Prevention, 2009
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Take the following into consideration:
 Which individuals are seen as trusted sources of
information about health practices and lifestyle by the
intended audience?
 What formats for receiving information are preferred?
 What is the preferred language for receiving the
messages?
 Consider adaptations to formats needed for
individuals with disabilities such as large print, Braille,
closed-captioning, etc.
Center for Substance Abuse Prevention, 2009
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Content of the message
Audience
Literacy levels
Language
Graphics
Format
Resource Limitations
Center for Substance Abuse Prevention, 2009
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Once potential materials are identified, determine
the following about each:
 Characteristics of the population for which they were
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developed
Credibility of the source of the medical information
When they were developed
Whether the information is still current and accurate
The cost to obtain or reproduce
Copyright issues or other restrictions
Availability in electronic format
Potential for customization
Center for Substance Abuse Prevention, 2009
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Ask members of the intended audience the
following questions:
 What was the main idea?
 Was the information new to you?
 Do you think you will change your ideas or
behaviors based on this information?
 What else should be included?
 Was it easy to read?
 Was it easy to understand?
Center for Substance Abuse Prevention, 2009
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Determine a plan that will bring the message to the
target audience. Where do they look for info?
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Local or minority newspapers or radio stations
Local advertising cultures
Faith-based organizations
Recreation centers
Grocery or convenience stores
Childcare facilities
Health clinics and doctors’ offices
Social and service clubs
Schools
Businesses
Center for Substance Abuse Prevention, 2009
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http://www.nccccurricula.info/glossary.html
http://www.ncsacw.samhsa.gov/files/TrainingPackage/MOD2/NationalClearingHouseTechnicalAss
istanceBulletin.pdf
http://captus.samhsa.gov/access-resources/ensuring-cultural-competence-organizational-level
http://captus.samhsa.gov/access-resources/elements-culturally-competent-prevention-system
http://captus.samhsa.gov/access-resources/infusing-cultural-competence-spf
http://captus.samhsa.gov/access-resources/needs-assessment-and-cultural-competencequestions-ask
Center for Substance Abuse Prevention. Identifying and Selecting Evidence-Based Interventions
Revised Guidance Document for the Strategic Prevention Framework State Incentive Grant
Program. HHS Pub. No. (SMA)09-4205. Rockville, MD: Center for Substance Abuse Prevention,
Substance Abuse and Mental Health Services Administration, 2009.
Denboba, D., U.S. Department of Health and Human Services, Health Services and Resources
Administration (1993). MCHB/DSCSHCN Guidance for Competitive Applications, Maternal and
Child Health Improvement Projects for Children with Special Health Care Needs.
Bronheim, S., & Sockalingam, S. (2003). A guide to: Choosing and adapting culturally and
linguistically competent health materials. National Center for Cultural Competence, Retrieved
from http://www11.georgetown.edu/research/gucchd/nccc/documents/Materials_Guide.pdf
http://quickfacts.census.gov/qfd/states/54000.html
Cathy Coontz, MA, MS, PSII, NPN
Prevention Lead for WV and
National Prevention Network for WV
Division on Alcoholism and Drug Abuse
Bureau for Behavioral Health and Health Facilities
350 Capitol Street, Room 350
Charleston, WV 25301
Cathy.E.Coontz@wv.gov