Cultural and Linguistic Competence and the CLAS Standards

1. Cultural and Linguistic Competence and the CLAS Standards Foundations and Definitions

2. Presenters • Cecily Rodriguez • Director, the Office for Cultural and Linguistic Competence • Office of Human Resources Development and Management • Department of Behavioral Health and Developmental Services • 804.786.5872 • Cecily.Rodriguez@co.dmhmrsas.virginia.gov • Dina Hackley-Hunt • Manager, Training and Staff Development • Blue Ridge Behavioral Healthcare • 3517 Brandon Avenue,Roanoke, VA 24018 • 540.982.1427, ext. 2129 • DHunt@brbh.org • Nhat Nguyen • Substance Abuse Counselor II • Alcohol and Drug Services – Youth Outpatient Services • Fairfax-Falls Church Community Services Board • 14150 Parkeast Cir., #200 • Chantilly, VA 20151 • 703.499.6108 • Nhat.Nguyen@fairfaxcounty.gov

3. Today’s Objectives • Introduce the foundations of cultural and linguistic competence • Explore what cultural and linguistic competence mean to you • Introduce the CLAS Standards as a framework for how to integrate cultural competence into your organization

4. Why Cultural and Linguistic Competence? • Growing Population diversity • Disparities in access and outcomes • Limited staff with CLC expertise • Lack of organizational and systemic focus on CLC Efforts • Legal requirements related to language access • Title VI- Civil Rights Law • CLAS Standards 4-7 • Federal and state expectations and accreditation criteria

5. WHAT IS CULTURAL COMPETENCE? National Center for Cultural Competence And incorporate the above in all aspects of policy making, administration, practice, service delivery and involve systematically consumers, key stakeholders and communities.

6. Definition of Linguistic Competence National Center for Cultural Competence The capacity of an organization and its personnel to communicate effectively, and convey information in a manner that is easily understood by diverse audiences including persons of limited English proficiency, those who have low literacy skills or are not literate, and individuals with disabilities.

7. National Standards on Culturally and Linguistically Appropriate Services (CLAS) • Organized by themes: • Culturally Competent Care (Standards 1-3) • Language Access Services (Standards 4-7) • Organizational Supports for Cultural Competence (Standards 8-14)

8. REMEMBER! • Using generalizations to understand a group of people is productive and helps one gain insight into communication styles and behaviors • Using stereotypes to categorize or judge people is destructive and discriminatory

9. Small Group Exercise • Introduce yourself to your neighbor • Identify your culture to your neighbor • Share a generalization about your culture to your neighbor • Share a stereotype about your culture to your neighbor

10. Why Do We Need to?

11. Changing Face of the United States • Changing demographic • Aging baby boomers • Growth of racial and ethnic minority groups to overtake non-Hispanic White population within the next 45 years • By 2015, non-Hispanic Whites will be primarily elderly population • By 2050, racial and ethnic minority group will account for 90% of the total population growth

12. Trends • Demographic changes, including • Rapidly increasing population growth • Increased cultural and linguistic diversity • Aging population • Eliminate long-standing disparities in the health status of people of diverse race, ethnicity and cultural backgrounds

13. Trends • Improve the quality of services and health outcomes • Gain a competitive edge in the market place • Decrease the likelihood of liability/malpractice claims • To meet legislative, regulatory and accreditation mandates

14. Cultural Competence Continuum Ignorance Sensitivity Competence Awareness Understanding

15. Truth about Competence • An awareness of diversity is NOT culturally competent • Only a handful of people or organizations can be culturally and linguistically competent • Organizations can be more competent and diverse in some areas than others • Organizations assume that their skills, services, approaches, or models apply to all cultures or groups

16. Perception

18. Perception You saw a couple in an intimate love position, right? Interestingly, research has shown that young children cannot identify the intimate couple because they do not have prior memory associated with such a scenario. What they will see, however, is nine (small & black) dolphins in the picture!

19. Perception So, I guess we've already proven you're not a young innocent child. Now, if it's hard for you to find the dolphins within 6 seconds, your mind is SO corrupted that you probably need help! OK, here's help: look at the space between her right arm and her head, the tail is on her neck, follow it up. Look at her left hip, follow the shaded part down, it's another one, and on his shoulder..

21. CLAS 1-3 Culturally Competent Care

22. Culturally Competent Care Standard 1 Health care organizations should ensure that patients/consumers receive from all staff member’s effective, understandable, and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language

23. Why be Concerned: Multiple Costs • Excess Preventable Deaths • Untreated Illness & Lower Achievement • Excess Hospital Admissions & Readmissions • Misdiagnosis & Poor Application • Community Suspicion and Mistrust • Staff Division and Conflict • Absence of Scientific Knowledge & Theory

24. Barriers to Help-Seeking • Fear of hospitalization – high death risks • Fear of treatment – loss of control • Self-reliance & determination • Racist slights • Stigma • Embarrassment, shame or guilt • Cost, but Under-use especially among middle class Africa Americans with health insurance

25. Summary of Differences • Admission Rates • Diagnoses • Length of Stay • Involuntary Commitments • Recidivism/Readmissions • Suicide Rates • Medication Prescribed • Co-Morbid Conditions • Use of Ministers/Native Healers • Participation in Research Studies • Help Seeking Patterns

26. Addressing the Five A’s of Disparities Availability • Does the service exist? Accessibility • If service exists, are they easily usable? Affordability • Can the potential consumer afford the service? • Can potential providers afford to provide the service?

27. Addressing the Five A’s of Disparities Appropriateness • Services produce desired clinical and functional outcomes? Acceptability • Does the cultural community receive the services as in keeping with norms, values and practices of the community?

28. Clinical and Service Delivery Enhancements • Fosters engagement and retention of populations of color in treatment • Service delivery strategies are incorporation of spiritual beliefs into the treatment of culturally different clients • Provision of services in the client's primary language through bilingual staff or interpreters • Use of culturally and linguistically appropriate assessment instruments

29. Clinical and Service Delivery Enhancements • Impacts the therapeutic relationship between the clinician and client, supporting the client's participation in treatment • Recognizes the dynamic interplay between "heritage" and "adaptation" in shaping human behavior • Heritage is the passing of tradition, beliefs, and values from older generations to younger generations • Adaptation is the ability to change one’s behaviors and attitudes to meet the demands of one’s environment

30. Clinical and Service Delivery Enhancements • Is able to utilize knowledge acquired about an individual's heritage and adaptation challenges to maximize the efficacy of assessment, diagnosis, and treatment • Internalizes this process of recognition, acquisition and utilization of cultural dynamics to routinely apply it to diverse groups

31. Care Coordination Neighborhood Multi-Service Center “The Services Mall” or “One-Stop Shop” Faith-Based (Pastoral) Consortium Primary Care Consortium Hospital Consortium Public School Consortium Courts & Police Consortium At all levels, cultural competence is not an endpoint, but an ongoing process of assessing people's needs and incorporating what is learned into the provision of services

32. Evidence-Based Practices (EBPs) • In culturally adapted service delivery, adjustments are made at the administrative, service delivery, and clinician levels to reflect the cultural knowledge, attitudes and behaviors of the target population • Culturally adapted care should be culturally competent care with ongoing assessments of needs and organizational resources • A key criticism of EBPs is that the research on which treatments' efficacy is evaluated rarely gives sufficient consideration to cultural and ethnic / racial factors

33. Culturally Competent Practices Modify approaches to: • Assessment and diagnostic protocols • Treatment and interventions • Medications protocols • Education and counseling • Consulting with traditional/indigenous practitioners and natural healers

34. Culturally Competent Practices Modify approaches to: • Intake interview protocols • Disseminating information • Partnering with consumers and families • Consulting and collaborating with cultural brokers • Coaching and mentoring (i.e. home, school, work, recreational settings)

35. Culturally Competent Practices Empower consumers to undertake: • Advocacy • Partnerships • Advisory groups • Board membership • Program staff and consultants • Knowledge beacon

36. Integrated Community Collaborative Care Individual Primary Care School Health Housing/Welfare Justice/Courts Substance Abuse Pastoral Care Dental Care Mental Health

37. Culturally Competent Care Standard 2 Health care organizations should implement strategies to recruit, retain, and promote at all levels of the organization a diverse staff and leadership that are representative of the demographic characteristics of the service area

38. Cost of Incompetence • Organizations in the United States waste billions of dollars in lost production, human energy, and stability due to our inability to solve primitive problems of how we perceive, interpret, and respond to human differences • Without understanding and change these costs will continue to increase

39. Why Have a Diverse Workforce • New ideas and perspectives • Increased motivation and buy-in • Increased organizational retention • Mainstreaming new talent • Accurate representation

40. Workforce Development • Cost Analysis • Benefit Analysis • Preparation/Staging • Action and Intentionality

41. What Are the Necessary Steps in Hiring Diverse and Culturally Competent Staff? • Become versed in how cultural and linguistic competency is reflected in the mission statement, policies, practices and procedures of the agency • Frame diversity and cultural and linguistic competency as essential components in how the agency measures excellence in service delivery • Recognize how our own background influences how we view difference (HOMEWORK) • Create an environment that actively fosters acceptance and respect for difference

42. ABCs to Increase Diversity • Determine program diversity, recruit culturally diverse staff that ideally reflects the cultural diversity of the individuals receiving services • Strategically post vacancy announcements in culturally diverse environments such as culturally specific community news papers, Web sites, list serves, multicultural agencies, and professional minority associations • Actively recruit a racially and culturally diverse staff as an ongoing practice

43. ABCs to Increase Diversity • Diversify hiring panels • Include cultural competence as a requirement in job descriptions • Standardize ways to assess a candidate’s ability to deliver culturally competent services • Hire staff who exhibit skills in culturally competent practice

44. An Effective Program-Organization • Distinguish cultural backgrounds, idioms and accents • Know about specific cultural dynamics but critical to stay away from simplistic solutions (one style does not fit all)

45. An Effective Program-Organization • Budget commitment to support Culturally and Linguistically Appropriate Services (CLAS) standards • Short but regular in-service sessions for employees that always includes a cultural competency topic • Ensures culturally-relevant policies

46. Where is Cultural Competence Needed Most? • Agency Vision & Mission • Organizational Values • Organizational Policies • Standards & Guidelines for Service • Service Delivery – Assessment & Interventions • Hiring Patterns & Staffing • Supervision • Training & Re-training • Agency Location

47. Improvements to Cultural Competency • Create strategic plan to ensure follow-through • Connect cultural competence to public image • Create cultural competent subcommittee as part of Quality Improvement Committee • Use the same processes for performance improvement and corrective action

48. Improvements to Cultural Competency • Tie cultural competence to cost • Include cultural competence in training curriculum, especially to key managers and Board members • Decrease the assumption that cultural competence is Affirmative Action – it’s not about African-Americans • Develop standards and guidelines

49. Culturally Competent Care Standard 3 Health care organizations should ensure that all staff at all levels and across all disciplines receive ongoing education and training in culturally and linguistically appropriate service delivery

50. Why be Concerned: Multiple Costs • Excess Preventable Deaths • Untreated Illness & Lower Achievement • Excess Hospital Admissions & Readmissions • Misdiagnosis & Poor Application • Community Suspicion and Mistrust • Staff Division and Conflict • Absence of Scientific Knowledge & Theory