Moving Your Health Service to the Next Stage of Cultural Competency

1. Moving Your Health Service to the Next Stage of Cultural Competency What’s the Next Step?

2. Presenters: David Braun, MD – University of Iowa Dwayne Sackman, MPA – Illinois State University

4. Goals • Present a self-assessment mechanism for any college health service. • Identify some potential challenges to increasing cultural competency. • Present some ideas on overcoming challenges and moving to the next stage of cultural competency

5. Cultural Competence Cultural Competence is when a community member is aware of his/her own assumptions, biases, and values; possesses an understanding of the worldview of others; is informed about various cultural groups; and has acquired the skills to develop appropriate intervention strategies and techniques (Sue, Arrendondo, & McDavis, 1992).

6. Assumptions Multiculturally competent persons understand: • One will never reach an ultimate level of knowledge and awareness about the self and various cultural groups. • One’s identity, awareness, and skills are constantly evolving in response to new information being received about the self or the other • One is continually seeking to raise awareness and develop skills that help to effectively address diversity and social justice issues. • One must develop the stamina to sit with discomfort, to continuously seek critical consciousness, and to engage in difficult dialogues (Watt, 2007).

7. A Self Assessment Tool • http://www.aafp.org/fpm/20020600/39achi.html • Achieving a more minority friendly practice Family Practice Management, June 2002, Vol. 9 No. 6 pg 39-43

8. Six Stages of Cultural Competence Development: • Cultural Destructiveness • Cultural Incapacity • Cultural Blindness • Cultural Pre-Competence • Cultural Competence • Cultural Proficiency

9. Journal of College Student Development Ingrid Grieger September/October 1996 Vol. 37 No. 5 “A Multicultural Organizational Development Checklist for Student Affairs”

10. Monocultural • Nondiscriminatory • Multicultural

11. A Personal Self-Assessment Tool • Diversity Awareness Profile (DAP), 2nd edition by Karen Stinson

12. Naïve – no awareness of one’s biases, prejudices, and negative behaviors • Perpetuator – aware of one’s biases, but continue negative behaviors and reinforce stereotypes • Avoider – tolerates other’s unjust behaviors • Change Agent – acts as a role model, takes action when appropriate • Fighter – always on lookout for prejudice and takes action at all times

13. 3 Phases to Move to the Next Level • Phase 1 – Structural • Phase 2 – Behavioral • Phase 3 – Cultural • “A Multicultural Organizational Development Checklist for Student Affairs” by Ingrid Grieger in Journal of College Student Development; September/October 1996, vol. 37 no. 5

14. Phase 1 – Structural • Develop vision • Communicate vision • Find leaders • Set low-hanging fruit goals • Form culture competency committee

15. Phase 2 – Behavioral • Create opportunities • Build momentum • Build rewards

16. Phase 3 – Cultural • Make part of ongoing operations • Commit financial resources in budget • Expand scope

17. An exercise for today • What would you do if. . . • . . .a patient expresses unwillingness to be seen by a provider because of racial/cultural differences?

18. An exercise for today • What would you do if. . . • . . .a senior provider tells you in a staff meeting that he’s “tired of the discussions of theory”?

19. Here’s one from Gropper: • The Athlete (page 74) • Charles Lear, an African-American whose family comes from the rural south, has been a patient at [the student health center] for over a year and Rita Barnes has been his regular nurse practitioner. The young man comes in for a physical examination because of a school requirement prior to participation on the track team. • Ms. Barnes is pleased that the youth is doing so well and asks, “What subjects are you taking this term, Charlie?” • He stiffens and mumbles, “English and math” and seems anxious to terminate the interview. • How would you explain this behavior?

20. Possible explanations • Charles is getting failing grades in his classes and is embarrassed to admit it. • Charles has had to wait longer than he expected before seeing Ms. Barnes, so he is in a hurry to leave. • In the rural South, African-Americans are raised to respect the name given to them by their parents and they do not convert it to a nickname as some other groups tend to do to demonstrate friendliness. Charles is startled by the liberties taken with his given name. • Charles does not like Ms. Barnes and wants to maintain his distance from her indirect communication of friendliness.

21. Video Conversation Starters • Short and not too edgy: “Color Me Blind” on YouTube, 5:39 video by WDrinker • Longer, edgy: “Hip-Hop: Beyond Beats and Rhymes” by Byron Hurt • Info at www.bhurt.com

22. A classic medical cultural competency book resource • The Spirit Catches You and You Fall Down by Anne Fadiman • www.spiritcatchesyou.com

23. Some additional resources • Gropper, R. Culture and the Clinical Encounter: An Intercultural Sensitizer for the Health Professions. Intercultural Press, Inc., 1996 • Wen-Shing, T. and Streltzer, J. Cultural Competence in Health Care: A Guide for Professionals. Springer Science + Business Media, 2008 • Galanti, G. Caring for Patients from Different Cultures. University of Pennsylvania Press, 2004

24. Nice Quick Clinic Reference • Mosby Pocket Guide to Cultural Health Assessment – Nursing Pocket Guides • Organized by country of origin with information on common religions, languages, cultural beliefs and common barriers to US health care