Evaluation in Minority Communities: Culturally Engaged Evaluation

1. Evaluation in Minority Communities: Culturally Engaged Evaluation Anthony J. Alberta Sonoran Research Group

2. Collaborators NDNS4Wellness, American Indian Prevention Coalition Bonny Beach, John Whiteshirt, Jr., John Whiteshirt, Sr., Boyd Tsosie,Sr., Boyd Tsosie, Jr. Larry Robinson, Salt River Pima-Maricopa Indian Community Elizabeth Stadick, Valle del Sol Ramon Valle, San Diego State University Sonoran Evaluation Group Molita Yazzie

3. Acknowledgements The presentation of these ideas is meant to convey my personal respect for the cultures, communities and people who have allowed us to work with them to develop new ways of knowing. Limitations I specifically intend to speak about my experiences trying to integrate indigenous wisdom and scientific knowledge, not to speak for anyone with whom we have worked.

4. Financial Acknowledgements United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment Center for Substance Abuse Prevention Center for Mental Health Services Grant Numbers TI13309, TI4254, TI14051, SMS4814

5. Definitions • Western European Culture: The culture of the industrialized democracies of central and northern Europe, identified by belief in humankind as dominant in the world. • Western European Science: The positivist, reductionist approach to the creation of knowledge through the application of specific, predefined methodologies documented through written communications. (My primary experience is with U.S. variant of Western European Culture)

6. Definitions • Indigenous Culture: The culture of agrarian or labor-based communities identified by belief in humankind as having a place in the world. • Indigenous Wisdom: The body of knowledge gained through the experience of a community in the world and maintained through an oral tradition.

7. Definitions Minority Community: A social unit whose access to power/resources is limited because their physical and cultural attributes do not conform to those established as “normal”, “good”, or “right” by a dominant community. Dominant Community: A social unit who have asserted control over definitions of “normal”, “good”, or “right” and use these definitions as the basis for allocating power/resources. “I came, I saw, I conquered.” Julius Caesar

8. Culturally Engaged Evaluation During the past twenty years, a rich literature concerning the affects of culture on the outcomes associated with behavioral health interventions. Sue, D. W., et al, 1982; Cross et al., 1989; Isaacs & Benjamin, 1991;  Davis, 1997.

9. Culturally Engaged Evaluation This work relies on a now widely recognized tripartite model of cultural competence through: Awareness of Cultural Differences Knowledge of Another Culture Specific Skills for Acting Competently

10. Culturally Engaged Evaluation In more recent literature, a number of authors have noted the value of recognizing communities’ strengths and the necessary role that members of minority communities must play in the definition of cultural competence. Delgado, 1998; Reynolds, 2001; Sue, 2001 These same concepts can inform our practice of evaluation in communities with cultural foundations outside that of the dominant, western European culture.

11. Culturally Engaged Evaluation Affective Communication Relationship Building Diunital Reasoning Customs and Practices Community-based Oversight Acknowledgment of Wisdom Shared Findings Model Management

12. Affective Communication Although many authors refer to communication skills as a necessary component of culturally competent interactions, these references typify the “specific skill” approach referred to above.

13. Affective Communication Thomason (1991) for example, describes a specific approach to initiating counseling with American Indians; Delgado (1998) refers to the importance of language and other methods of conveying thought and meaning in Latino culture Locke (1989) discusses specific methods for addressing differences in speech patterns between African-American children and school counselors.

14. Affective Communication Culturally engaged evaluation calls for the use of observation to adopt the communication style of the people or person immediately at hand.

15. Affective Communication • Evaluators should attempt to emulate the tone of voice, use of hand gestures, amount of eye contact, pace of speech, and voice volume of the group s/he is working with. • Note that the model does not call for the evaluator to mimic the communication style of the others, but to emulate it – to try to bring her/his own behavior in line with that of the people s/he is working with, instead of attempting to precisely act it out

16. Affective Communication The model refers to “affective communication” because language represents both an important aspect of cultural competence and, at times, an overrated one. Members of different cultural groups, for example, may share a language but still experience a sense of disaffection in their relationships with one another. This example also demonstrates the difference between cultural competence (the ability to speak the language of another culture) and cultural engagement (the ability to effectively interact with members of an unfamiliar culture).

17. Relationship Building Western European culture presupposes the development of professional relationships based on credentials, market-based criteria and other “objective” factors Indigenous cultures, on the other hand, tend to rely more heavily on personal relationships as the foundation for professional relationships (Ramirez, 1998, pp 18 - 21).

18. Relationship Building At times, evaluators confuse “methodology” with “objectivity”. • Western European science requires evaluators to use a specific, pre-defined methodology. It does not require us to have no interest in the outcomes of our work.

19. Relationship Building Evaluators seeking to practice successfully in multi-cultural situations, then, should consciously set out to establish personal relationships with members of the communities in which they work. • Within Culturally Engaged Evaluation, we recognize our ethical obligation to methodology, not objectivity.

20. Diunital Reasoning Described by Myers (1988), diunital reasoning is the skill of recognizing the validity of two competing, even exclusionary, world views. In some of the cross-cultural psychological literature diunital reasoning is sometimes known as cognitive dissonance (Valle, 1998).

22. Customs and Practices Evaluators can use a number of resources to develop an understanding of the customs and practices of a culture other than their own. Any of these sources may provide either erroneous information, or information that does not accurately describe the practices of a particular subgroup of some larger cultural group. As a result, evaluators cannot rely solely on any source outside the members of a specific cultural milieu as they enter culturally unfamiliar territory.

23. Customs and Practices In Culturally Engaged Evaluation, understanding customs and practices begins with observation. Within the model, observation consists of three distinct components: Identifying patterns of behavior; Identifying the values and expectations that underlie the behavior; Using the information to enlarge one’s understanding of the world view supported by the culture (Valle, 1998). BE HUMBLE

24. Community-based Oversight • Members of the community involved in the Evaluation are best suited to provide oversight of participant protection activities. • Institutional Review Boards and Ethics Committees with a majority of members who share the cultural/ethnic/racial background of study participants can inform the oversight process. • The requirement to avoid conflicts of interest usually precludes participation on IRB’s/EC’s by people from the community actually involved in the Evaluation.

25. Community-based Oversight Community-based advisory groups comprised of members of the community involved in the evaluation can help select methods, review instruments, and guide evaluators as they work in the community. Members of the advisory group may also become involved in letting community members know about the evaluation – it’s purpose, what it means for the services, and what it means for the community.

26. Acknowledge Wisdom “I’m trying to figure out how to work your science thing into what I know to be true about the world.” Boyd Tsosie, Sr.

27. Acknowledge Wisdom Indigenous communities have always created knowledge. That’s “knowledge”, not “folklore”.

28. Acknowledge Wisdom This knowledge has included individual technological innovations such as: Hammers Blades Wheels Levers Fire

29. Acknowledge Wisdom As well as entire fields of knowledge, including things like: Cooking Ceramics Agriculture Astronomy Education Weaving Engineering

30. Acknowledge Wisdom Indigenous cultures also developed knowledge with regard to healing practices. The teleological, holistic and collectivist approach of indigenous healing practices capitalizes on the demonstrated role of expectation, belief, and human relationship in the healing process.

31. Acknowledge Wisdom 1. 50% of the effect of anti-depressants has nothing to do with the medication. 'Listening to Prozac but Hearing Placebo' Sapirstein and Kirsch, presented at the 104th convention of the American Psychological Association, 1996. 2. Open administration makes pain killers work better. Response Variability to Analgesics... Amanzio et al, Pain, 90 (2001) 205-15.

32. Acknowledge Wisdom What’s my point? Indigenous knowledge is as valid and legitimate as scientifically derived knowledge. Asking community members to share their community’s wisdom with us – and incorporating that wisdom into our work - begins to address the power imbalance that defines relationships between “majority” and “minority” community members.

33. Acknowledge Wisdom • Grounding Evaluation in the knowledge base of the communities in which we work will enhance the relevance of the our work in those communities. Applying Culturally Engaged Evaluation, then, may lead to the development of new ways of knowing through the integration of indigenous and scientific knowledge.

34. Share Findings • Share data with community members on a regular basis. This sharing should include involving community members in the interpretation of findings.

35. Model Management One might think of the model as a circle, with each of the skills fused with the others and forming a whole. Failure to employ one of the skills will break the circle and significantly reduce one’s ability to conduct culturally engaged practice.

36. Affective Communication Relationship Building Community-based Oversight Acknowledgment of Wisdom Diunital Reasoning Customs and Practices Shared Findings Model Management Culturally Engaged Evaluation

38. Anthony J. Alberta 602-369-0075 ajalberta@sonoranresearchgroup.com www.sonoranresearchgroup.com