WLH Consulting Group “ Ensuring Effective Human Service Delivery” Cultural Competence in Prevention Practice: Organizat

1. WLH Consulting Group “Ensuring Effective Human Service Delivery” Cultural Competence in Prevention Practice: Organization/Agency/Program Activities NC SPF-SIG Learning Community RTI International 3040 East Cornwallis Road RTP, North Carolina 27709 June 14, 2010 Facilitator: Wilbert L Hardy, Ph.D., M.S.W.

2. What is Cultural Competence? Behaviors + Attitudes + Policies = Effectiveness in cross-cultural situations Affects Substance Abuse Prevention Outcomes positively = Reduction of Substance use/abuse Cultural Competence Definition

3. National – develop/establish/monitor policy State--establish and monitor policy Community--implement policy, provide input, monitor service delivery Organization/Agency/Program--deliver prevention services Individual--deliver prevention services Cultural Competence Levels of Responsibility

4. Some Factors Affecting Cultural Competence • Culture • Race/Ethnicity • Language • Gender • Disability • Sexual Orientation/Lesbian/ Bi-sexual/Gay/Transgender/Questioning • Age • Socio-economics • Rural

5. Seven Domains of Cultural Competence • Organizational values • Governance • Planning, monitoring, evaluation • Communication • Staff Development • Organizational Infrastructure • Services, intervention

6. Knowing Cultural Competence When We See It: Components of A PROFILE • Domains of Cultural Competence • Focus Areas Within Domains • Indicators Relating to Focus Areas • Low, Moderate, High, Performance Anchors/Measures

7. Cultural CompetenceDomains Domain #1 • Organizational Values: An organization’s perspective and attitudes regarding the worth and importance of cultural competence, and its commitment to providing culturally competent services. Focus Areas within Domain • Leadership, Investment and Documentation • Information/Data Relevant to Cultural Competence • Organizational Flexibility • Evaluation

8. CC Domains continued… Domain #2 • Governance: The goal-setting, policy-making, and other oversight vehicles an organization uses to help ensure the delivery of culturally competence “services”. Focus Areas within Domain • Community Involvement and Accountability • Board Development • Policies • Evaluation

9. CC Domains continued… Domain #3 • Planning and Monitoring/Evaluation: The mechanisms and processes used for: a) long- and short-term policy, programmatic, and operational cultural competence planning that is informed by external and internal consumer; and b) the systems and activities needed to proactively track and assess an organization’s level of cultural competence. Focus Areas within Domain • Client, Community and Staff Input • Plans and implementation • Collection and Use of Cultural Competence-Related Information/Data • Evaluation

10. CC Domains continued… Domain #4 • Communication: The exchange of information between the organization/providers and the clients/population, and internally among staff, in ways that promote cultural competence.. Focus Areas within Domain • Understanding of Difference Communication Needs and Styles of Service population • Culturally Competence Oral Communication • Cultural Competence Written/Other Communication • Communication with Community • Intra-Organizational Communication • Evaluation

11. CC Domains continued… Domain #5 • Staff Development: An Organization’s efforts to ensure staff and other service providers have the requisite attitudes, knowledge and skills for delivering culturally competent services. Focus Areas within Domain • Training Commitment • Training Content • Staff Performance • Evaluation

12. CC Domains continued… Domain #6 • Organizational Infrastructure: The organizational resources required to deliver or facilitate delivery of culturally competent services.. Focus Areas within Domain • Financial/Budgetary • Staffing • Technology • Physical Facility/Environment • Linkages • Evaluation

13. CC Domains continued… Domain #7 • Services/Interventions: An organization’s delivery or facilitation of Evidenced-based Prevention Services in a culturally competent manner. Focus Areas within Domain • Community/Population Input • Needs Assessment • Program Planning • Program, Practice, Intervention. Strategy, Policy Selection • Evaluation

14. Cultural Competence IndicatorsImmediate • Formal cultural competence-related policies exist regarding: -Personnel recruitment/retention -Training/Staff development -Language Access/Communication -Community/Service Participant Input • Mechanisms for collection of cultural competence-related information/data • Material expressing the organization’s commitment to cultural competence • Obtains client-level cultural competence related information

15. Cultural Competence IndicatorsImmediate continued.… • Mission Statement addresses Cultural Competence. • Strategic Plan addresses Cultural Competence, including a Cultural Competence Plan. • Integration and implementation of Cultural Competence Plan • Reports to stakeholders on Cultural Competence activities/Issues • Monitoring and evaluation reports related to Cultural Competence.

16. Cultural Competence IndicatorsImmediate continued… • Conducts regular community/needs assessments including specific sub-populations if needed • Membership on relevant planning committees of community participants that represent groups served • Resources and capacity to collect/manage/report cultural competence-related information/data • Process for obtaining client/community input in the development of cultural competence-related plans • Participant satisfaction regarding cultural competence-related planning and Service Delivery • Staff satisfaction regarding cultural competence-related planning and service delivery

17. Cultural Competence IndicatorsIntermediate • Systematic and ongoing examination and use of information/data relevant to cultural competence • Administrative and service delivery adaptations tailored to population in services area, including adaptations to improve access to services • Fidelity/Adaptation of Evidenced- Based Programs • Data sources and systems that support proactive cultural competence planning at all levels including policy development, program planning and implementation

18. Cultural Competence IndicatorsIntermediate continued…. • Monitoring and evaluation reports related to cultural competence • System for identification and recording of population’s and client’s language preferences, level of proficiency, and literacy • Linguistically competent services provided • Staff demonstrates/applies effective communication styles with diverse groups • All staff complete basic/initial and periodic cultural competence training • Training in cultural competence linked to cultural competence • Cultural competence is a part of job descriptions • System of incentives (individual, team, & agency) for cultural competence behaviors/activities

19. Cultural Competence IndicatorsLong Term • Formal and informal alliances/links with community and other partners to address cultural competence issues • Prevention Practice Guidelines that account for differences related to culture in the delivery of prevention services. • Flow and feedback of cultural competence-related information/data for use in policy, program, operations, and service delivery planning and implementation • Conducts regular organizational self-assessments regarding cultural competence • Requires/facilitates regular individualprevention provider assessments regarding cultural competence

20. SAMHSA’sStrategic Prevention Framework & Cultural Competence

21. Profile population needs, resources, and readiness to address needs and gaps Sustainability & Cultural Competence Monitor, evaluate, sustain, and improve or replace those that fail Mobilize and/or build capacity to address needs Implement evidence-based prevention programs and activities Develop a Comprehensive Strategic Plan SAMHSA’s Strategic Prevention Framework Steps Assessment Evaluation Capacity Planning Implementation

22. Outcomes-based prevention • Effective prevention is grounded in a solid understanding ofalcohol tobacco and other drug consumption and consequence patterns. • Documenting the nature and extent of consumption (e.g., underage drinking) and consequences (motor-vehicle crashes) at the start is critical for determining intervening variables and aligning strategies to address them.

23. Foundation for Cultural Competence Measurements and RequirementsGrounded in SPF-SIG • Build a state and program level data base consisting of the following descriptive information: • Types of plans and strategies designed to implement culturally appropriate policies, programs and practices; • Organizational capability and experience of awardees in implementing culturally appropriate/ competent tailored prevention interventions; • Utilization, reliability and validity of culturally appropriate psychometric methods and measures; • Types and utilization of culturally appropriate adaptations with evidence based programs policies, and practices

24. Measuring Cultural Competence: Development Steps • HRSA Cultural Competence Assessment framework (Lewin Group staff, Expert Panel, site visits) for health providers • Adapted for prevention with a Panel of Expert Consultants from across America with WestatCorporation and the National Cross-Site Evaluation Team

25. Measuring Cultural Competence Development Steps • Seven Domains, with Focus Areas and a set of Indicators • Domains mapped onto the SPF-SIG steps • Indicators adapted for the SPF-SIG process (by Westat Team) • Additional indicators derived form review of SPF state-reported activities • Anchors/Measures developed by Westat • Assessment Instruments developed Using Indicators and Anchors

26. Measuring Cultural Competence Development Steps continued… • Result X [<44] sets of indicators, allow scoring/scaling within domains and/or SPF Steps • Progress on each indicator scored - Ratings of Low, Moderate, High levels of Implementation/Accomplishments/Performance • Self Assessment Instruments developed with some indicators in multiple domains

27. Measuring Cultural Competence Development Steps Continued… • Repeat scoring at several time points - Quarterly Reports - Semi-annual Community Level Assessments/Scoring - State Level Assessments/Scoring - State, Community, Program, & Individual Assessments/Scoring

28. Cultural Competence Measures: Process Indicators: Low, Moderate, High • Rate Cultural Competence level of organizations and prevention services using scales for each domain and indicator • Compute an overall Cultural Competence score • Validation: correlate Cultural Competence scores with measures of SPF implementation success • Correlate changes in Cultural Competence scores with changes in State epidemiological outcomes and prevention National Outcome Measures.

29. North Carolina Prevention Outcomes Performance Measures • Abstinence from drug use/alcohol abuse • 30-day substance use (non-use/reduction in use) • Age of first substance use • Perception of Disapproval/Attitude • Perceived risk/Harm of use

30. North Carolina Prevention Outcomes Performance Measures continued… • Increased Employment/School Retention • Perception of Workplace Policy • School Attendance and Enrollment • Decreased Criminal justice Involvement • Alcohol-related Car Crashes and Injuries • Alcohol and Drug Related Crime

31. North Carolina Prevention Outcomes Performance Measures continued... Increased Access to Services (Service capacity/Retention in Service Programs) -- Number of persons served by Age, Gender, Race, and Ethnicity -- Youth seeing, reading, watching, or listening to prevention message

32. North Carolina Prevention Outcomes Performance Measures continued... • Increased social support/social connectedness • Family Communication around drug use • Cost-Effectiveness • Cost efficiency of services • Increased Use of evidence-based practices • Total Number of Evidence-based Programs, Policies, and Practices

33. Foci for allPrevention Activities should be linked to Cultural Competence • Federal and State Funded Prevention Activities require: • Culture Competence Consideration in all Prevention Activities; • Performance, Effective Service Delivery, and Outcomes Management;

34. Foci for Prevention Activities and Cultural Competence continued... • Federal and State Funded Prevention Activities • Require: • Data-driven Strategies, Policies, & Programs for all Populations • Data Collection, Analysis, and Reporting on Cultural Competence Activities for all Populations • Correlation of Cultural Competence Strategies, Policies, and Programs to National, State, Community, and Local Substance Abuse Prevention Outcomes

35. THE END! Wilbert L. Hardy, Ph.D., M.S.W. President & CEO, WLH Consulting Group 2303 Fieldstone Place Greenville, North Carolina 27858 Telephone: (443) 280-0815 (Preferred) Telephone: (252) 756-5590 (Alternate) E-mail: wlhardy12@embarqmail.com