Cultural Competency and Adolescent Health

2. Cultural Competency and Adolescent Health

3. Outline • Cultural Competency and Adolescent Healthcare: What Does It Mean? • Adolescent stages of development • Identities and disparate health outcomes • Movements to decrease bias and optimize health service delivery

4. Objectives • By the end of this presentation, participants will be able to: • Discuss the relationship between culture and health in the context of adolescent-friendly services • Describe the intersection of patient-centered care and cultural competency • Utilize the framework of cultural humility to minimize provider bias and optimize health outcomes

5. Cultural Competency and Adolescent Health • What does is it mean to provide culturally competent care to adolescents? • How does the “culture of adolescence” differ from commonly held notions of culture? • How does the culture of adolescence interact and coexist with racial and ethnic cultures?

6. Adolescence • Prolonged developmental stage separating childhood and adulthood • Normally occurs between ages 11-22 • Needs vary by development and personal circumstances • Shaped by race, ethnicity, religion, socioeconomic status, family/peers

7. Stages of Adolescence • Early • Middle • Late

8. A spurt of growth Beginning of sexual maturation Concrete thinking Early Adolescence

9. Mid-Adolescence • Develop a stronger sense of identity • Relate more strongly to peer group • Thinking becomes more reflective

10. Late Adolescence • The body fills out and takes its adult form • Distinct identity and more settled ideas and opinions

11. The Culture of Adolescence • Peer dependent • Egocentric • Distinct language and dress • Influenced by popular culture • Ongoing search for identity

12. An Adolescent’s Identity Includes: Religion/ Spirituality Race and Ethnicity Genetics Socioeconomic Status Geography Peer Group Ability Stage of Development Gender Identity Sexual Orientation Family Structure

13. “Minority” Status in One or More Aspects of an Adolescent’s Identity Can Affect: • How and where healthcare is sought • Ability to obtain and pay for quality care • Patient-healthcare provider interaction • Societal stereotyping and marginalizing

14. Living in Poverty Decreases the Likelihood of Having Health Insurance • 3.3 million (one in eight) adolescents ages 12-17 lack health insurance • 8 million (one in four) youths ages 18-24 are uninsured

15. Lack of Insurance Can = Lack of Care • Insured teens receive care twice as often as uninsured adolescents • In a survey of adolescent girls: • 50% of uninsured reported foregoing needed care • More than twice the rate of insured girls

16. These Factors Can Lead to Health Disparities, Including: • Higher incidences of sexual risk behaviors • Higher rates of: • Pregnancy • STIs • Depression • Drug and alcohol use

17. For Example…

18. For the General Population, Teen Pregnancy Rates Have Continued to Declined Guttmacher Institute, 2006

19. Disparities Persist Between Racial Minorities and Whites Pregnancies per 1,000 women aged 15-19, 2002

20. Lesbian, Gay, and Bi Adolescents Report Greater Sexual Risk Behaviors

21. How Can Providers Improve These Health Outcomes?

22. Strategies for Providing Optimal Care • Cultural Competency • Cultural Humility • Adolescent-Centered Care

23. Cultural Competency • Movement to address health disparities through provider education • Trainings often required by many funders, accreditation bodies, and institutions

24. Most Common Definition of Cultural Competency • Cultural and linguistic competence: • A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations. (Cross, et al. 1989)

25. Cultural Competence: Strengths • Brings culture into the discussion about manifestation of disease and notions of health • Encourages providers to learn about cultures of patients served • Supports respect for cultural differences and diversity

26. Cultural CompetenceProvider Guidelines • Increase knowledge about how culture influences behaviors and outcomes • Develop an awareness of providers’ and patients’ cultural issues and their effect on the medical encounter • Understand the importance of appropriate language and the use translators

27. Cultural Competency in Practice • Listen with understanding to the patient's perception of the problem • Explain your perceptions of the problem and your strategy for treatment • Acknowledge and discuss the differences and similarities between these perceptions • Recommend treatment while remembering the patient's cultural parameters • Negotiate agreement. Understand the patient's explanatory model so medical treatment fits in cultural framework Berlin EA, Fowkes WC.1983

28. Weaknesses in “Cultural Competency” • Not clearly defined • Denotes attainment of concrete level of knowledge • Risks cultural stereotyping • Focus on others instead of reflecting on individual and organizational biases and prejudices

29. Building Upon Cultural Competency -> Cultural Humility

30. Cultural Humility • Puts onus on provider to self-evaluate how personal biases may affect service delivery • Redresses power imbalances in patient-physician dynamic Tervalon and Murray-Garcia, 1998

31. Healthcare Providers’ Identities Profession Race and Ethnicity Medical Specialty Marital Status Parental Status Sexual Orientation Training Background Gender Identity Age Religion

32. Healthcare Provider: Issues to Confront Before Seeing an Adolescent Patient • How comfortable are you talking to adolescents? • What are your feelings/beliefs about adolescent sexuality? • Are you able to separate your own values in order to treat your patient?

33. Cultural Humility: Self-Evaluation During a Clinical Encounter • How do you react when confronted with a patient situation that does not fit your expectations? • Does the situation provoke feelings of anxiety and discomfort? • Are you able to assess what is going on within yourself as well as within the patient? www.diversityRx.org

34. Cultural Competence and Cultural Humility Combined: Adolescent-Centered Care

35. Adolescent-specific Multi- and interdisciplinary Accessible Financially affordable Adolescent-focused materials on display Peer educator component Adequate space Confidential Flexible scheduling Comprehensive services Continuity of care Help transitioning into the adult medical care system Elements of Adolescent-Centered Services:

36. Three-Dimensional Provider: Providing Care to the Three- Dimensional Adolescent • Confront personal biases head on • Be prepared to refer patient for appropriate care if unable to provide it

37. Adolescent-Centered Care • Assure confidentiality • Invite parents to wait in waiting room • Explain why you will be asking sensitive questions • Treat each patient as an individual, acknowledging all the interacting forces that make him/her unique

38. Ways to Provide Culturally Competent, Adolescent-Centered Care • Ask a question and listen to the response! • Wait 30 seconds until you speak after each question • Answers will help identify how culture interacts with patient’s health decisions • Utilize HEEADSSS

39. The HEEADSSS Model • H: Home • E: Education/Employment • E: Exercise/Eating • A: Activities • D: Drugs • S: Suicide/Depression • S: Sexuality • S: Safety • S: Spirituality (Optional)

40. Other Clinical Interview Tools • GAPS: AMA Guidelines for Adolescent Preventive Services • Bright Futures: Collaboration between AAP and Bureau of Maternal Child Health Care) • Trigger Questionnaire: Developed by Office of Managed Care in the New York State Department of Health • ACOG Tool Kit: Designed by the ACOG Committee on Adolescent Health Care to help every office care for adolescent patients

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