Cultural Sensitivity in Diverse Communities

1. Cultural Sensitivity in Diverse Communities Dr. Charles Amrhein William Brandshagen Dr. James Kiffer Dr. Lee Underwood Smart Responses in Tough Times: Achieving Better Outcomes for People with Mental Illnesses Involved in the Criminal Justice System July 15-17, 2009

2. Competency & Motivational Strategies: Understanding Miscues Lee A. Underwood, Psy.D., Clinical Director Arizona Department of Juvenile Corrections

3. Class Objectives • Define terms associated with cultural competency • Discuss the cultural competency continuum • Discuss perceptions and how communication miscues occur • Discuss motivational strategies for juveniles • Identify ways to become more culturally competent

4. Definitions • Let’s make sure we are all on the same page by defining some words associated with…Cultural Competency

5. Related Terms Institutionalized Racism • Also referred to as Structural or SystemicRacism • A form of racism which is structured into political and social institutions • Occurs when institutions, including corporations, governments and universities, discriminate either deliberately or indirectly, against certain groups of people to limit their rights. • Reflects the cultural assumptions of the dominant group, so that the practices of that group are seen as the norm to which other cultural practices should conform

6. Related Terms Institutionalized Racism cont’d • More subtle, less visible, and less identifiable than individual acts of racism, but no less destructive to human life and human dignity. • The people who manage our institutions may not be racists as individuals, but they may well discriminate as part of simply carrying out their job, often without being aware that their role in an institution is contributing to a discriminatory outcome.

7. Cultural Competence Continuum Ignorance Awareness Sensitivity Understanding Competence

8. Ignorance Is… the state or fact of being ignorant: lack of knowledge, education, or awareness

9. What Ignorance Looks Like Unaware of biases, prejudices or their impact on others. Unaware of pain and damage to others Unaware behavior is offensive. Accept stereotypes as facts.

10. Cultural Awareness being cognizant, observant, and conscious of similarities and differences among cultural groups

11. What Awareness Looks Like Aware of biases and prejudices. Aware that their behavior offends others. But still may behave in ways that reinforce and reward bigotry.

12. Cultural Sensitivity is…. the ability to adjust one’s perceptions, behaviors, and practice styles to effectively meet the needs of different ethnic or racial groups

13. What Sensitivity looks like Aware of biases in selves and others. Work on their prejudices, reluctant toaddress inappropriate behavior of others.Play it safe by saying nothing.Silent supporters.

14. Cultural Understanding is… understanding the needs and emotions of your own culture and the culture of others

15. What Understanding looks like Aware of biases in selves and others. Willing to take action when they encounter inappropriate words, behaviors. Respond in way that is fair to others.

16. Cultural Competency is… • a set of skills, knowledge and attitudes, which enhance an individual’s: • awareness of his or her own assumptions and values as well as other prevailing attitudes toward culture within the United States; • understanding of and respect for other’s values, beliefs and expectations; and • the ability to adapt his or her interactions to be more in touch with other’s expectations and preference.

17. What Competency looks like Constantly aware of any behaviors that seems to be biased or prejudiced.  Question actions of others and confronts people about such behaviors.

18. Iceberg Metaphor Only 10% of an iceberg is visible (conscious) whereas the other 90% is beneath the water (preconscious and unconscious). The Preconscious is allotted approximately 10% -15% whereas the Unconscious is allotted an overwhelming 75%-80%. ------------------------------------- -------------------------------------

19. Perceptions

20. Cultural Miscues • Brief and commonplace daily verbal, behavioral or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory or negative racial slights and insults. • People are generally unaware that they engage in such communication when they interact with racial/ethnic minorities. • A taxonomy (list) of examples was created through a review of the literature

21. Examples of Cultural Miscues THE STATEMENT THE MESSAGE THE THEME You are not American. You are a foreigner. When a person is assumed to be foreign born Where are you from? Where were you born? You speak good English. People of color are generally not as intelligent. It is unusual for someone of your race to be so intelligent You are a credit to your race. You are so articulate Assigning intelligence A white man or woman clutches purse or wallet as a person of color passes. A store owner following a customer of color around the store Criminality /assumption of criminal status You are a criminal. You are dangerous. You are going to steal.

22. Offensive Statements • “Indian giver” • “That’s so gay.” • “She welshed on the bet.” • “I jewed him down” • “That’s so white of you.” • “You people . . .” • “We got gypped.”

23. Motivational Strategies Motivational Interviewing (Rollinick & Miller) • A directive, client-centered counseling style for eliciting behavior change • Helps clients to explore and resolve ambivalence • A focused and goal directive approach • The examination and resolution of ambivalence is its central purpose

24. Motivational Strategies Spirit of Motivational Interviewing • Motivation to change is elicited from the client, and not imposed by the therapist • It’s the client’s task, not the counselor’s, to articulate and resolve his or her ambivalence • Direct persuasion is not an effective method for resolving ambivalence • The counseling style is generally a quiet and elliciting one

25. Motivational Strategies Spirit of Motivational Interviewing • The counselor is directive in helping the client to examine and resolve ambivalence • Readiness to change is not a client trait, but a fluctuating product of interpersonal interaction • The therapeutic relationship is more like a partnership or companionship than expert/recipient roles

26. Motivational Strategies You violate the spirit of Motivational Interviewing when you: • Argue that the person has a problem and needs to change • Offer direct advice • Prescribe solutions to the problem without the person’s permission or without actively encouraging the person to make his or her own choices • Use an authoritative/expert stance leaving the client in a passive role

27. Motivational Strategies You are violating the spirit of Motivational Interviewing when you: • Do most of the talking • Function as a unidirectional information delivery system • Impose a diagnostic label • Behave in a punitive or coercive manner

28. Motivational Strategies Transtheoretical Model of Change (Prochaska and Diclemente): • Illustrates the process of change people go through • A sequence of stages through which people typically progress as they think about, initiate, and maintain new behavior • Can assist the counselor and program staff with identifying ways to support and guide the client through the process

29. Stages of Change PERMANENT EXIT PRE- CONTEMPLATION Prochaska and DiClemente’s “six stages of change”. Taken from: Miller and Rollnick (1991), “Motivational Interviewing”, Guilford Press.

30. Putting the Pieces Together Culturally competent service providers are supportive mentors and coaches who: • Value diversity • Conduct self-assessments • Manage the dynamics of differences • Acquire and incorporates cultural knowledge • Adapts to diversity and the cultural contexts of the individual they serve *National Center for Cultural Competence

31. Putting the Pieces Together Culturally competent delivery systems: • Have vision, mission and values that support diversity and cultural competency • Offers on-going training at all points of contact • Elicit feedback from clients and staff *National Center for Cultural Competence

32. Putting the Pieces Together Culturally competent delivery systems: • Have a CQI and program fidelity component • Have updated policy and procedures that are in concert with its vision, mission and values • Willingly examines disproportionate minority confinement at all decision points

33. Putting the Pieces Together Culturally competent delivery systems have the following treatment components: • Screening and assessment • Classification and reclassification • Multi-Disciplinary Treatment Team (MDT) • Treatment and transition planning • Core and specialty treatment services • Family support and involvement

34. Dr. Charles AmrheinClinical Director, BronxTASC Mental Health CourtProgram, NY

35. Guam and Micronesiaa History of CulturalDiversityPresented by: James Kiffer, PhDandW. J. “Brandy” Brandshagen

36. Pre-contact Micronesia Throughout the islands much of the pre-contact information has been lost to time. Most of the documentation of pre –contact Guam and Micronesia was made by Spanish Priests sent to convert the indigenous people to Catholicism. Islanders had a different sense of privacy and ownership. This was the cause for much discord between the islanders and the Europeans.

37. Magellan Lands on Guam 1521 The people living on Guam called themselves Chamorros. On one of Magellan’s ships there was a bloody altercation during which a small rowboat was taken (borrowed??). In return the Spanish burned a village and took their boat back. Guam and Micronesia then became known as: “Islas De Las Ladrones” or “Islands of the Thieves”

38. The Extended Family As is in many traditional societies the fundamental social unit was and still is the extended family. The extended families were large numbering in the hundreds, they were from the same village or clan. Today on Guam, as is with many other cultures the “family” includes everyone from Great Grandparents to the forth cousin twice removed, “family” can also include very close, but non-related friends.

39. “PINEKSAI”(Reared) A common practice until after WWII, it is when the first child of the eldest child or the first grandchild was given to the grandparents to raise as a daughter or son. This was done to insure that when the grandparents become old and need assistance there would always be someone in the home to help them.

40. A Matrilineal Society The mothers lineage determined ownership of property and land rights. The Priests disapprovingly reported  “in the home it is the mother that rules and her husband does not dare give an order contrary to her wishes, nor punish the children, for she will turn upon him and beat him.” Spanish forcibly changed this female dominated lifestyle to a Western based patriarchy, - Can you imagine the culture shock that caused?

41. Religious Beliefs Ancestor Worship – venerating the spirits of those who came before. The Suruhanu – Spirit Doctor – healing the sick DANGEROUS SPIRITS Taotaomona – the people of before Duendes – Mischievous Elves Fanague – To be visited by the ghost of a deceased relative Not considered to be unusual

42. RESOURCES The resources of the ocean were not considered free for all. Outsiders who exploited family property owed compensation to the owners. The Spaniards and later the Americans were unaware or indifferent to this custom, which was the cause for many additional problems. Today there are still strong arguments for indigenous fishing rights.

43. KNOWLEDGE A concept that was a surprise to the Europeans was that knowledge was considered to be private property and not shared with strangers. Some knowledge such as medicine or magic was considered more secret. Today many Pacific Islanders are often evasive or answer a question with what they assume will be pleasing, although not necessarily accurate, to the questioner.

44. ISLAND CULTURE IMPACTED by TIME, TIDE, TYPHOON, & EARTHQUAKE by political manipulations and by WAR.  Guam has never had a voice in its own destiny - In 1521 the island became a colony of Spain In 1898 Guam became an American colony as part of the spoils of the Spanish American war. On December 8, 1941 Guam was attacked and taken by the Imperial Forces of Japan. July 21, 1944 Guam was retaken by the Navy, Army and Marine Corps. Since then, Guam has been a Territorial possession of the United States of America.

45. QUESTIONS? Information for this presentation was provided from a variety of sources: I would especially like to thank: Dr. Robert F. Rogers author of Destiny’s Landfall (1995 University of Hawaii Press) Mr. Jay J. Perez Ms. Bernie M. Rosario Mr. and Ms. Francisco Arceo and family (my Guam family)

46. Thank you For further information & conference presentations please visit www.consensusproject.org This material was developed by presenters for the July 2009 event: “Smart Responses in Tough Times: Achieving Better Outcomes for People with Mental Illnesses Involved in the Criminal Justice System.” Presentations are not externally reviewed for form or content and as such, the statements within reflect the views of the authors and should not be considered the official position of the Bureau of Justice Assistance, Justice Center, the members of the Council of State Governments, or funding agencies supporting the work.