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2. AND THE JOURNEY CONTINUES: Achieving Cultural and Linguistic Competence in Systems Serving Children and Youth with Special Health Care Needs and their Families

3. Tawara D. Goode & Wendy Jones National Center for Cultural Competence Georgetown University Center for Child and Human Development University Center of Excellence in Developmental Disabilities October 15, 2007

4. Soliciting Stories from the Road • the story collection process • key partners and stakeholders • methodology • collaborators Source: And the Journey Continues…Achieving Cultural and Linguistic Competence in Systems Serving Children & Youth with Special Health Care Needs and their Families. Goode, Jones, Dunn & Bronheim, 2007 Slide Source: National Center for Cultural Competence,2007

5. Soliciting Stories from the Road • 23 stories from 18 states and 1 territory MO, NJ, NM, NC, ND, OK, TN, UT, WA, WI AK, CT, FL, GU, IL, KS, KY, MA, MS, Source: And the Journey Continues…Achieving Cultural and Linguistic Competence in Systems Serving Children & Youth with Special Health Care Needs and their Families. Goode, Jones, Dunn & Bronheim, 2007 Slide Source: National Center for Cultural Competence,2007

6. How are the states and territories traveling? • Many of the stories focused on varied aspects of linguistic competence, including: • increasing access to care and • enhancing the capacity to respond to emerging populations speaking languages other than English Source: And the Journey Continues…Achieving Cultural and Linguistic Competence in Systems Serving Children & Youth with Special Health Care Needs and their Families. Goode, Jones, Dunn & Bronheim, 2007 Slide Source: National Center for Cultural Competence,2007

7. How are the states and territories traveling? • Policy- Most stories focused on compliance with federal and/or state policies related to language access. • Structures- Stories reflected a trend in reinvigorating or using existing structures to plan for and implement enhanced language access services. • Practices- an array of practices were identified that involved the use of technology, and training to build new skill sets for personnel. Source: And the Journey Continues…Achieving Cultural and Linguistic Competence in Systems Serving Children & Youth with Special Health Care Needs and their Families. Goode, Jones, Dunn & Bronheim, 2007 Slide Source: National Center for Cultural Competence,2007

8. How are the states and territories traveling? • Procedures- Several stories indicated development of new procedures for linguistic competence. • Dedicated resources- None of the stories addressed budgetary or funding issues related to language access. Source: And the Journey Continues…Achieving Cultural and Linguistic Competence in Systems Serving Children & Youth with Special Health Care Needs and their Families. Goode, Jones, Dunn & Bronheim, 2007 Slide Source: National Center for Cultural Competence,2007

9. How are the states and territories traveling? • Value diversity- All stories demonstrated an understanding of and a value for diversity among populations served and personnel. • Conduct self-assessment- several stories described engaging in organizational self-assessment resulting in changes in practice and procedures • Manage the dynamics of difference- community partnerships, training and staff development were major strategies used to address difference. Source: And the Journey Continues…Achieving Cultural and Linguistic Competence in Systems Serving Children & Youth with Special Health Care Needs and their Families. Goode, Jones, Dunn & Bronheim, 2007 Slide Source: National Center for Cultural Competence,2007

10. How are the states and territories traveling? • Acquire and institutionalize cultural knowledge- Several stories documented initiatives to acquire knowledge and information about specific racial, cultural, and ethnic groups; none of the stories described policies, structures and practices to institutionalize the function of acquiring cultural knowledge throughout the organization. Source: And the Journey Continues…Achieving Cultural and Linguistic Competence in Systems Serving Children & Youth with Special Health Care Needs and their Families. Goode, Jones, Dunn & Bronheim, 2007 Slide Source: National Center for Cultural Competence,2007

11. How are the states and territories traveling? • Adapt to diversity and the cultural contexts of communities served- All of the stories reflected a compelling need to adapt services for families and communities. None of the stories identified approaches to evaluate the effectiveness of service adaptations or policy changes necessary to sustain such efforts Source: And the Journey Continues…Achieving Cultural and Linguistic Competence in Systems Serving Children & Youth with Special Health Care Needs and their Families. Goode, Jones, Dunn & Bronheim, 2007 Slide Source: National Center for Cultural Competence,2007

12. WATCH FOR SIGNS ALONG THE ROAD!! Detour Stop Sign U-Turn Proceed with Caution Hidden Entrance Work Zone Divided Highway New Traffic Pattern Hazardous Driving Conditions Watch for Pedestrians & Cyclists Slow Speed Toll Ahead T.D. Goode Slide Source: National Center for Cultural Competence,2007

13. LESSONS OF THE JOURNEY • Leadership • SharedOwnership • The “ISMs”- Confronting the Undercurrents • Keeping it Real • Weave into the Fabric of the Organization T.D. Goode Slide Source: National Center for Cultural Competence,2007

14. LEADERSHIP • cultivating leadership at all levels • leaders (with & without authority) • revisiting the role of the leader T.D. Goode Slide Source: National Center for Cultural Competence,2007

15. Fears and Concerns about Cultural & Linguistic Competency “If I am asked to learn about cultural competence, then they must be implying that I am incompetent!” “If I am authentic about this, I will stir up a hornet’s nest in this place. Then there will be repercussions. I am not willing to take that risk.” “I have examined studies about various cultures, changed some of my thoughts, and now I feel competent.” “There are too many cultures. I can’t possibly learn about all of them. This is futile.” “I am a person of color. I know what it means to be culturally competent. I don’t need any special training.” “If we really get into this my colleagues will discover that I don’t know as much as I think I need to know.” “I may discover I have more biases than I care to admit.” Slide Source: National Center for Cultural Competence, 2007

16. Considering Cultural & Linguistic Competence within the Context of Organizational Change Adaptive Challenge vs. Technical Challenge Does making progress require changes in people’s values, attitudes and or habits of behaviors? Reference: Heifetz, R.A. (1994). Leadership Without Easy Answers. Cambridge, MA: The Belknap Press of Harvard University Press Slide Source: National Center for Cultural Competence,2007

17. The Work of the Leader • Get on the Balcony • Identify the Adaptive Challenge • Regulate Distress • Maintain Disciplined Attention • Give the Work Back to the People • Protect Voices from Below Slide Source: National Center for Cultural Competence,2007

18. Leadership: Lessons Learned • Leadership to advance and sustain cultural and linguistic competence must be cultivated at all levels of an organization, system, or community. • Some individuals lead through position, others through influence; both are valued and necessary and must be recognized. • The traditional role of the leader must be revisited and adapted to address ongoing or emerging challenges: organizational change processes, differences across and within cultures and resulting dynamics, resistance, and differences in power. Slide Source: National Center for Cultural Competence,2007

19. Are we on the same page? Culturally aware Cultural humility Culturally relevant Cultural sensitivity Culturally competent Culturally & linguistically competent Multicultural Competence Culturally appropriate Linguistically competent Culturally effective Cultural Proficiency T.D. Goode Slide Source: National Center for Cultural Competence,2007

20. SHARED OWNERSHIP • on the same page • (conceptual frameworks & definitions) • “Oh that’s only for people of color.” • the indispensable opposition • getting “buy in” T.D. Goode Slide Source: National Center for Cultural Competence,2007

21. Shared Ownership: Lessons Learned • Staff, families, community partners, and key stakeholder need to be on the same page with a shared understanding of the conceptual frameworks and benefits of cultural and linguistic competence. • Culturally and linguistically competent health and mental health systems and organizations should involve and benefit all. • Structures to advance and sustain cultural and linguistic competence must be inclusive to be effective. Slide Source: National Center for Cultural Competence,2007

22. THE “ISMs” Confronting the Undercurrents • Call it what it is! • create a climate of intolerance • offer a safe refuge for authentic discussions • use conflict management & resolution • invoke legal interventions when necessary T.D. Goode Slide Source: National Center for Cultural Competence,2007

23. The “ISMs”: Lessons Learned • Addressing racial and ethnic disparities in health and mental health care demands an intentional focus on conscious or unconscious bias, prejudice, stereotyping, and discrimination. • Efforts to advance and sustain cultural and linguistic competence will have little or no success unless the “ISMs” are confronted with integrity, in a humane and effective manner. Slide Source: National Center for Cultural Competence,2007

24. Organizational Change Theories Applied to Cultural & Linguistic Competence Resistance is a characteristic of any major organizational change effort and a major reason why organizational change efforts fail. (Prochaska, Prochaska and Levesque, 2001). Resistance should be expected in different stages of multicultural organizational change because the topics of prejudice, discrimination and oppression are controversial and emotionally charged. (Brantley, Frost and Razak, 1996). The Transtheoretical Model of Change suggests that it is counterproductive to forge ahead with action without addressing issues such as resistance, that stand in the way of individual and organizational readiness for change. Data Source: Mayeno, L. Multicultural Organizational Development: A Resource for Health Equity, in Cultural Competence in Health Care Series, The California Endowment and Compasspoint Nonprofit Services, April 2007. Slide Source: National Center for Cultural Competence,2007

25. KEEPING IT REAL • create & nurture a community of learners • make training relevant • tailor to individual interests, preferences & needs • incorporate into specific job functions & • performance measures • offer incentives T.D. Goode Slide Source: National Center for Cultural Competence,2007

26. Keeping it Real: Lessons Learned • Create and nurture a community of learners as part of the organization’s commitment to promote continuous professional growth and development for staff, volunteers, and board members to acquire the knowledge and skills necessary to advance and sustain cultural and linguistic competence. • Provide highly relevant training and technical assistance based on individual interests, needs, and preferred learning methods of staff. Consider formal and informal learning opportunities, such as continuing education/academic courses, coaching, mentoring, shadowing, language instruction, book clubs, visiting scholar/practitioner programs, and other experiential activities. Slide Source: National Center for Cultural Competence,2007

27. Keeping it Real: Lessons Learned • Revisit position descriptions and job functions to ensure they define the qualities, experience, knowledge, and skills sets needed to promote culturally and linguistically competent services and supports. • Establish a system of incentives that acknowledges and celebrates staff efforts and achievements in advancing and sustaining cultural and linguistic competence. Slide Source: National Center for Cultural Competence,2007

28. Weave into the Fabric of the Organization • eliminate the perception of “add on” • establish the business case • link to quality of care • legitimize in policy, structures, • practices, procedures, & resources • set bench marks & measure progress • at regular intervals • assure it is woven into the “culture” of • the organization T.D. Goode Slide Source: National Center for Cultural Competence,2007

29. Weave into the Fabric of the Organization and Lessons Learned • Eliminate the perception of cultural and linguistic competence as “add-ons” by ensuring principles and practices are woven into the culture of the system or organization. • Establish a clear business case for cultural and linguistic competence within the specific contexts of the system, organization or program. • Promote the understanding that cultural and linguistic competence are integrally linked to quality of care—you can’t have one without the other. • Institutionalize cultural and linguistic competence in policies, structures, practices, procedures and dedicated resources within systems and organizations. • Establish bench marks and measure progress at regular intervals. Slide Source: National Center for Cultural Competence,2007

30. What are the leadership implications for cultural & linguistic related to … • CORE FUNCTIONS • What we do ….. • HUMAN RESOURCES & STAFF DEVELOPMENT • Who we are … • FISCAL RESOURCES & ALLOCATION • Where the money goes … • COLLABORATION & COMMUNITY ENGAGEMENT • Who our partners are … • CONTRACTS • Whom do we entrust to deliver services and supports … Data Source: Excerpt from Planning for cultural and linguistic competence in State Title V programs serving children and youth with special health care needs and their families , NCCC, 2004 T.D. Goode Slide Source: National Center for Cultural Competence,2007

31. Cultural and linguistic competence It’s a life’s journey … not a destination Safe travels! T.D. Goode Slide Source: National Center for Cultural Competence, 2007