Building Bridges to Cultural Competency

1. Building Bridges to Cultural Competency Center for Public Health Education Stony Brook University The Center for Public Health Education

2. Who We Are: A Cultural Perspective Module I The Center for Public Health Education

3. Welcome • Introductions • CPHE • RTC • COE • HRSA • Cell Phones and Pagers • Housekeeping • Postcards The Center for Public Health Education

4. Introductions • Name • Agency • Position • What do you expect to get out of this training? The Center for Public Health Education

5. Notes . . . . • Three basic goals • To increase knowledge about the impact of culture on the delivery and accessing of health and human services • To increase knowledge about the impact of power and privilege on the delivery and accessing of health and human services • Assist providers in their attempt to become culturally competent The Center for Public Health Education

6. Training Objectives • Define culture • Define power and privilege • Examine the cultural competency continuum • Examine how cultural personal, social and family experiences influence assumptions and perceptions • Review the effects of perceptions, assumptions and stereotypes on health and human service delivery • Examine the relationship between culture and privilege The Center for Public Health Education

7. Training Objectives • Explore the effects of privilege on accessing healthcare • Define cultural competency • Demonstrate the need for cultural competency in the health and human service setting • Review the cultural values of western medicine in a multi-ethnic and multi-cultural society • Describe the impact of culture on accessing and delivering health and human services • Review strategies for enhancing cultural competence The Center for Public Health Education

8. Ground Rules . . . . • What are some ground rules we should establish? • Does the group agree on the suggestion? The Center for Public Health Education

9. Ground Rules . . . . • It’s okay to pass • Listen actively-respect others while they are talking • Respect each others right to have an opinion other than you own • Speak from your own experience instead of generalizing (Use I statements) • Refrain from personal attacks • Keep an open mind to explore other ideas, values and opinions • Allow yourself to examine personal beliefs and attitudes The Center for Public Health Education

10. Definitions . . . How would you define culture? Culture – the total way of life of a group of people, including their beliefs, institutions, and technology. The Center for Public Health Education

11. Definitions . . . • Culture- “ a system of shared values, beliefs, ideas and learned patterns of behavior, explicit and implicit, which a people use to interpret the world. Art, literature and history of a society, but also less tangible aspects such as language, attitudes, prejudices and folklore can impact a persons’ culture. Cultural identity influences how a person behaves and acts, what they believe and what they actually know . . .” The Center for Public Health Education

12. Definitions . . . . • Historical Underpinnings – Events that occurred in the past which may affect how a particular individual or community perceives events or reacts to specific issues The Center for Public Health Education

13. Definitions . . . . • External Factors – Issues/events occurring around the world which may affect an individual. • Access Barriers – Prevent individuals from using existing services. These barriers may be cultural, individual, physical, financial or structural. The Center for Public Health Education

14. Points to Consider • Culture is a very broad concept • Perceiving, assuming and stereotyping are part of the “human condition” • Providers need to be aware so this “human condition” does not interfere with the delivery of services The Center for Public Health Education

15. Cultural Postcard • Review your list of your own cultures and subcultures. • I.- Can you add any other cultures or subcultures based on the lecture? The Center for Public Health Education

16. A Look Inward: Examining Personal Experiences Module II The Center for Public Health Education

17. Cultural Competence • Gaining cultural competence is a process • In order to achieve higher levels of competence, it is helpful to engage in self assessment • Self assessment provides direction for improvement The Center for Public Health Education

18. Cultural Competence Model Cultural Blindness Cultural Incapacity Cultural Proficiency Cultural Destruction Cultural Competence Cultural Pre-Competence The Center for Public Health Education

19. Cultural Competence Continuum • Cultural Destructiveness • The negative end of the spectrum • Refers to the blatant attempts to destroy the culture of a given group • Assumes that one group is superior over another • Acknowledges only one way of being and purposefully denies or outlaws any other cultural approach The Center for Public Health Education

20. Cultural Competence Continuum • Cultural Incapacity • The capacity is lacking to be responsive to different groups, though not intentional • Ignorance and unfounded fear is often the underpinning of the problem • Failure to recognize when mistreatment is due to cultural differences and there by perpetuating its occurrence The Center for Public Health Education

21. Cultural Competence Continuum • Cultural Blindness • Blindness or ignorance of cultural differences • Perceives of themselves as “unbiased” • The believe that culture makes no difference in the way a person or group acts or reacts • Fosters the assumption that we are all basically alike so what works with members of one group will work with members of all other cultures The Center for Public Health Education

22. Cultural Competence Continuum • Cultural Pre-Competence • Movement toward cultural sensitivity • Actively pursues knowledge about differences and attempts to integrate this information into delivery of services • Recognizes that cultural differences exist but those differences are acknowledged as “differences” and nothing more • Learning and understanding of new ideas is encouraged along with solutions to improve performances or services The Center for Public Health Education

23. Cultural Competence Continuum • Cultural Competence • The capacity to function in an effective manner within the context of the targeted group • Acceptance and respect of differences • Continual expansion of knowledge about the target group • Actively seeks advice and consultation • Committed to incorporating new knowledge and experiences into a wider range of practice The Center for Public Health Education

24. Cultural Competence Continuum • Cultural Proficiency • The positive end of the spectrum • Proactively regards cultural differences • Promotes improved cultural relations among diverse groups • Holds culture in very high esteem • Regarded as a specialist in developing culturally sensitive practices The Center for Public Health Education

25. Cultural Postcard • II-A. Where do you fall on the Cultural Competence Continuum? The Center for Public Health Education

26. Cultural Competence Model Cultural Blindness Cultural Incapacity Cultural Proficiency Cultural Destruction Cultural Competence Cultural Pre-Competence The Center for Public Health Education

27. Eight Questions: Personal Memories Activity • Choose one culture that has had the most influence on you • You will have the opportunity to be the interviewer and the person interviewed • Obtain the answers to questions 1-7 • You will use the information to formulate an answer to question 8 • Switch roles The Center for Public Health Education

28. Eight Questions: Personal Memories Activity • Human beings are complex • Beliefs, values and traditions come from cultural and life experiences • Cultures we are born into and cultures we embrace shape who we have become The Center for Public Health Education

29. Eight Questions: Personal Memories Activity • Individuals may belong to the same culture, but may not share the same experiences • There may be greater differences within a culture than between cultures The Center for Public Health Education

30. Power and Privilege: Making Privilege Visible Module III The Center for Public Health Education

31. What is Power? The ability to achieve aims or further the interests you hold even when opposed by others; or as the ability to impose one’s will on others, even if those others resist in some way. The Center for Public Health Education

32. What is Privilege? An unearned right, advantage or immunity granted to or enjoyed beyond the common advantages of all others; an exemption in many certain cases from burdens of liabilities. The Center for Public Health Education

33. What is Privilege Those with privilege rarely understand it’s full impact on those who do not have privilege The Center for Public Health Education

34. The “I” Statements • The “I” statements reflect privileges enjoyed by different groups or cultures in our society. • The lists are not inclusive of all privileges, but provide a basic overview and help to identify some unearned privileges. • Privileged groups are usually unaware of their privilege The Center for Public Health Education

35. The “I” Statements • Having privileges is not always a negative • Privileges should not taken away, but shared with all members of society • When only certain members of society enjoy privileges, it creates inequities • Once all members of a society enjoy the same privilege, it no longer is a privilege but has become an equal right for all members of society The Center for Public Health Education

36. White Privilege • I can move wherever I want to move • I can do well in a challenging situation without being called a credit to my race • I can go into a supermarket and find the staple foods which fit my cultural traditions • I can take a job without my coworkers suspecting I got it because of my race • My medical provider will be aware of cultural values and traditions related to my healthcare The Center for Public Health Education

37. Male Privilege • When competing against a female for a job, the odds are probably in my favor • My odds of being raped are low • I can be assertive without being called a bitch • If I have sex with a lot of people, it will not make me an object of contempt or stereotyping • I am not expect to spend my entire life 20-40 pounds underweight The Center for Public Health Education

38. Heterosexual Privilege • When I talk about my intimate relationships I will not be accused of pushing my sexual orientation onto others • People do not ask me when I decided to be heterosexual • I can marry and enjoy all the legal benefits associated with marriage • I can hold hands in public with my significant other • I can count on finding a health and human service provider willing and able to talk about my sexuality The Center for Public Health Education

39. Non-Trans Privilege • My validity as a man/woman/human is not based upon how much surgery I’ve had • I am not expected to constantly defend my medical decisions • Strangers do not ask me what my “real name” is • People do not disrespect me by using incorrect pronouns • I do not have to worry about whether I will be able to find a bathroom to use or whether I will be safe changing in a locker room The Center for Public Health Education

40. Able-bodied Privilege • If I need to move, I can be assured of purchasing a home I can get access to easily • I can be assured that my entire neighborhood will be accessible to me • I can be assured that assumptions about my mental capabilities will not be based on my physical limitations • I can take a job without someone suspecting I got my job because of my physical status • I can turn on the TV or open the newspaper and see people of my physical ability represented The Center for Public Health Education

41. The Effect of Privilege on Accessing Health and Human Services • Presenting western medicine as superior to all other medical beliefs • Having a health and human service provider that only sees the physical challenge and not the whole person • Providers who ignore the need to be culturally competent The Center for Public Health Education

42. Effect of Privilege on Accessing Health and Human Services • Providers who refuse to provide health and human services within a neighborhood • Providers that exclude individuals from clinical trails based on gender or using information from clinical trails based on other races. The Center for Public Health Education

43. Addressing Privilege • Inequities and discrimination occur when power and privilege are not equally shared by all members of society • Legislative attempts to level the playing field have not always been successful • Inequities that are part of a society’s structure or system are not always adequately addressed by laws • Laws have no power when addressing invisible privilege The Center for Public Health Education

44. Addressing Privilege • Lawmakers have attempted to address imbalance • This is often met with resistance • Women’s suffrage movement was met with great resistance and required a constitutional amendment to allow women to vote • Current debate allowing gays and lesbians the right to marry has met with opposition, including an attempt to pass an amendment banning gay marriage The Center for Public Health Education

45. Making the Connection • Membership in multiple privilege groups result in additional invisible privileges. • Members with the most privileges tend to have the most power in society. • White, heterosexual, able-bodied, males typically have the most privileges in our society. The Center for Public Health Education

46. Making the Connection • When privilege remains invisible it is difficult to see how it effects the privileged and the unprivileged. • Becoming aware of privilege can lead to feelings of guilt for some • It is important not to let guilt paralyze • Guilt can politicize • Recognizing privilege may help to address inequity The Center for Public Health Education

47. Cultural Postcard • III. List any privileged groups or cultures you belong to. The Center for Public Health Education

48. Bowling for Privilege • Choose ten privileges that are most desirable • As a group pick the most important privilege • Arrange privileges like bowling pins with the most desirable as the first bowling pin. The Center for Public Health Education

49. Bowling for Privilege In your groups, answer the following question: • What privilege was most important? • Which groups commonly have this privilege? The Center for Public Health Education

50. Bowling for Privilege • Two members from each group will have one chance each at knocking down the pins • After one member goes, reset the pins • Each group must keep score of how many pins were knocked down. • The group that knocks down the most pins wins The Center for Public Health Education