Download cultural competency

“An organization’s ability to recognize,
respect, and address the unique needs,
worth, thoughts, communications, actions,
customs, beliefs, and values that reflect an
individuals racial, ethnic, religious, and/or
social groups or sexual orientation.
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CARF Standard Manual
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Learn about resources and tools that could
assist your organization with creating its
cultural competency plan.
Assist your staff to develop an understanding
of the values and beliefs of the individuals
they support and how the tools will assist
them with providing respectful, individualized
and effective services and supports.
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Diversity is a growing part of our lives.
◦ People are choosing to live in places that are
different from where they were born.
◦ Woman and the elderly are employed more than
ever
◦ Speed of travel and communication has increased
◦ People with disabilities are working and living in the
community
◦ A growing expectation that diversity will be
respected in public policy, business practices, and
social services.
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Knowledge
Attitudes
Behaviors
Skills
Policies
Protocols
Programs
Resources
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Effective methods
to work across
cultures
Respect, empathy,
awareness, insight
Ongoing process
Embraces change
Avoids stereotyping
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By 2050, minorities will represent 54% of the
US population.
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Source: U.S. Census Bureau
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This table reflects the years when white becomes the
minority group by age:
Total Population
Age
Age
Age
Age
Age
under 18
18 – 29
30 -44
45 – 64
65 +
2043
2018
2027
2035
2051
after 2060
Source: William H. Frey, Brookings Institution analysis of U>S> Census Bureau population projections 2012
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The integrated pattern of human behavior that
includes the thoughts, communication,
actions, customs, beliefs, values, and
institutions of a racial, ethnic, religious,
social, or other group.
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R.E.G.A.R.D.S.
• Race
• Ethnicity
• Gender
• Age
• Religion
• Disability
• Sexual Orientation
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A classification of people based in part on distinctive
physical characteristics such as skin color; a
socially-constructed not biologically-constructed
aspect of humanity.
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Special groups within a race who are defined by
ancestry, cultural heritage, language, nationality, or
religion, or a combination of these human
characteristics.
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White
England
Black
Africa
Scotland
Ireland
Haiti
Jamaica
Cuba
China
Mexico
Central
America
South
America
Italy
Russia
Asian/
Pacific
Islander
Puerto Rico
Poland
Scandinavia
Hispanic/
Latino
Dominican
Republic
Spain
Japan
The
Philippines
Vietnam
Cambodia
Korea
Samoa
Native
American
Middle
Eastern
Egypt
Hundreds
of tribes
in North
America
including:
Iran
Yemen
Palestine
Cherokee,
Navajo,
Apache,
Blackfoot,
Inuit.
Lebanon
Jordan
Saudi
Arabia
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Gender ◦ To include gender identity: a person’s innate perception of
gender which may not correspond to one’s sex
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Age (including generational differences)
Religion
Disability
Sexual Orientation
◦ Emotional and physical attraction to others of a particular
sex (other, same or both)
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The five elements of cultural competence
include:
◦ Valuing diversity.
◦ Being able to understand your own cultural views
(and those of organizations or systems).
◦ Being aware how culture may be affecting a
situation.
◦ Being able to learn about other cultures. Finding
ways to share and build on that knowledge.
◦ Being able to change your behavior to meet the
needs of others and their cultures.
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The first step to cultural competency is
understanding your own culture –
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What is family?
Where you live now and where you have lived before
How your family shared meals
How you celebrated holidays, and religious events
Gender roles
Your education
How much money you have
Your own disability, or that of a family member
Social customs and etiquette
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Individuals/ Organizations who
◦ Do not value diversity.
◦ Do not recognize culture. They see cultural
differences as expressions of "right" and "wrong."
◦ Do not desire to learn more about other cultures.
◦ Will resist changing behavior to meet the needs of
others.
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Have little understanding about their own prejudices.
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May believe in the following types of stereotypes:
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Gay men are child molesters.
African-Americans are less intelligent than European-Americans.
Women are not as good as men at math and science.
American Indians drink too much.
Women on welfare have babies to avoid working.
Muslims are terrorists.
Jews are rich.
People with developmental disabilities are dangerous.
A Korean neighbor will eat your pet dog.
Homeless people are drug abusers or lazy.
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Individuals/ Organizations who
◦ Value diversity, but only superficially.
◦ See culture as a surface feature.
◦ Desire to learn more about other cultures but resist
or do not understand some important information.
◦ Will resist changing their behavior to meet the
needs of others when the behavior reflects a deeper
value choice.
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Individuals/ Organizations who
◦ Value diversity and are beginning to understand
some of the deeper cultural differences.
◦ See culture as important. However, they find it
difficult to understand.
◦ Sometimes they are able to recognize when culture
is affecting a situation.
◦ Want to learn more about other cultures, yet lack
information and resources.
◦ Do not know how to change behavior to meet the
needs of others.
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Individuals/ Organizations who
◦ Value diversity. They understand why it is personally and
professionally valuable to them.
◦ See culture as part of everything and understand that
culture affects the daily choices that people make.
◦ Understand that interactions always require some level
of cultural competence.
◦ Actively develop and use a variety of resources for
learning more about different cultures.
◦ Willing to change their behavior to meet the needs of
others.
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Communication volumes (loudness) vary
among cultures? Baseline speaking is
generally lower among Asians and Western
Europeans. Americans tourists in these parts
of the world are often seen as rude and
thoughtless.
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Personal Space
Eye contact
Speaking volume
Touch
Time
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Influenced by:
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Gender
Status
Degree of intimacy
Space available
Differences in “business size” space and “personal
size” space
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The duration and frequency of eye contact
communicates a great deal but differs widely
among cultures. For example:
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Among Latinos, it is respectful to avoid direct eye
contact with authority figures.
Southern Europeans generally engage in more eye
contact than Americans.
Asians, direct eye contact is brief, especially with
superiors or members of the opposite sex.
Diversity Council 2008
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Volume as well as the words we speak, varies
among cultures.
◦ For example, white Americans interpret raised
voices as a sign of anger while other ethnic groups
such as Latin Americans or Africans, raised voices
are simply an exciting conversation.
◦ In some African cultures, whispering is a sign of
witchcraft or plotting.
Diversity Council 2008
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Compared to other cultures, Americans rarely
touch each other, limiting ourselves to
handshakes or pats on the back.
Latin Americans touch with much
frequencies. In these cultures, it is not
uncommon for two men to hold hands,
showing nothing more than friendship
Touching someone on the head is offensive
to most Asians
Diversity Council 2008
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The way we use time also sends a message
without a word being spoken. For example:
◦ In American business culture the emphasis is on
punctuating while in Latin and Middle Eastern
cultures, value is placed on the relationship so a
meeting continues until it reaches a natural
conclusion, even if you are late for the next one.
Diversity Council 2008
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Low context communicators (For example, American macro culture,
Northern European) tend to:
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Emphasize straightforward, logical speech.
Are impatient with silence or indirect language (such as story telling).
Communicate primarily with words.
Are unaware of the past or think it is irrelevant.
Are less formal, more likely to extend equal status to all speakers.
High context communicators (For example, African-American, Asian,
Native American, Latino) tend to:
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Be highly tuned to body language.
See the past as important as the present.
Rely less on words and more on the whole situation.
Use indirect language, story telling, and silence to convey messages.
Are more formal, taking into account status and position to guide interactions.
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Smile at customers (Russia)
Look someone in the eye when they are
speaking (in parts of Africa)
Not let your friend smell your breath (in some
Arab cultures)
Brag about your credentials in a job interview
(in the Netherlands)
Bring white flowers to a host’s house (in
China)
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A way of improving our service
delivery
A way of expanding our capacity to
work with one another
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Value Diversity
Assess themselves
Mange the dynamics of difference
Acquire and institutionalize cultural
knowledge
Adapt to diversity and the cultural
contexts of individuals and
communities served
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Nodding the head up and down does not always
mean “yes”?
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In the Middle East, when they nod the head down,
it indicates agreement. While nodding it up means
they disagree.
In Japan and most of Asia including the Philippines,
nodding up-and-down is a way to show that
someone is listening and is interested with what
you are saying.
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How does a particular culture view:
 Illness and disability
 Role of Family
 Decision making authority
*Please note the following tools note differences in communication
styles and values; but are to be used with caution to avoid stereotyping.
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http://mindlink.org/online_courses/cultural_competency_1.htm
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Culture Clues (http://depts.washington.edu/pfes/CultureClues.htm)
Includes information on relationships, norms about eye contact & body language
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Diversity Tip Sheet: Cross-Cultural Communication,
Translating Nonverbal cues and Communicating with
Non-Native English Speakers
http://diversity.missouri.edu/learn/language.php
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Two million children are being raised by
lesbian, gay, bisexual or transgender parents.
Children of gay and lesbian parents live in 96%
of U.S. counties
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Am I using the correct terminology?
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Are our service delivery processes flexible?
 Do I know how to reference same sex couples in their child’s IP?
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Am I aware of unique barriers individuals
may be experiencing?
 Typically LGBT Adults are more likely to be estranged from their
biological family; and more likely to rely on friends and
community members as their chosen family
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A resource that includes: terms to Use; terms to
avoid; parenting & adoption and marriage for same
sex couples
http://www.lgbtmap.org/allys-guide-to-terminology
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Eid al-Fitr is an Islamic Holiday with
significant work restrictions
Recommended Accommodations: Avoid scheduling
important meetings, events, or activities on this
date. Employees will likely ask to take a vacation
day on this day, and that request should be granted
if at all possible. If planning an evening event,
provide food accommodations if requested (Islamic
dietary restrictions apply).
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Are we aware and attentive to the religious
and spiritual needs of:
 consumers
 their families
 and staff?
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This website identifies major holidays and
suggested accommodations
http://diversity.missouri.edu/get-involved/religion/holidays.php
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Do you have an awareness of your actions as it
relates to the individual’s culture?
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Attire
Take off shoes, when enter home?
Accept food/drink if offered?
Where do you sit?
How reference individual- Mr. Smith or Tom…
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Do you have an awareness of your actions as it
relates to the individual’s culture?
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Understand how culture influences decision making
Explain why you must ask personal or sensitive
questions (such as: level of assistance needed
when bathing)
Respect a families decision to use home treatments
consistent with their culture
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What is your history? What is your home of origin? Why did you/your family
settle in ____?
What are some of your family customs?
What are the roles of members within your family? What is your role?
What are the gender roles in your culture? And in your family?
How are decisions made at the family level?
What are your family beliefs about raising children? Discipline?
What are the practices of people who are considered to be excellent parents in
your culture?
Source:
http://www.d.umn.edu/~hrallis/courses/1100sp04/assignments/learn_cultures_qs.html
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is a commitment to:
 culturally competent personnel
 culturally appropriate services
 culturally competent organizations
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Assessment
Planning
Review
Areas to cover:
(1) governance and organizational infrastructure (2)
services and supports (3) planning and continuous
quality improvement (4) collaboration (5)
communication and (6) workforce development
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From CARF Connection March/April 2006
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Do our services align with the beliefs and practices of the people we serve?
Of the people within our organization?
2. Do the languages we speak, write, and sign within our organization include or
exclude stakeholders?
3. Do we understand the unspoken pressures, issues, and cultural group norms
that might affect how the person responds to our services?
4. Do we respond to regional differences or rural versus urban environments in
which we operate?
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Cultural Competency & Diversity Plan that
includes: person served, personnel and
other stakeholders
Addresses culture, age, gender, sexual
orientation, spiritual beliefs, socioeconomic
status and language
Reviewed at least annually
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A. Identify the cultural characteristics within
your community
 Evaluate demographics of your organization
and the community
 Are there unserved or underserved groups in
your community?
B. Conduct Assessments
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http://oseda.missouri.edu/
Who is OSEDA? Office of Social and Economic Data Analysis
Mission: OSEDA collaborates with partners in the analysis of
social and economic data in ways that contribute to
improvements in the well-being of people, enterprises and
communities.
Priority Issues
 Improving the quality of public education
 Improving state and local government services.
 Improving the health status of people
 Improving the social strength of communities
 Improving the capacity for economic development
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Statistic
St. Charles
Missouri
National
English speaking
93%
94%
79%
Spanish speaking
4%
3%
13%
Caucasian
88.97%
83.12%
74.17%
African American
6.26%
11.53%
12.56%
Asian
1.82%
1.61%
4.81%
American Indian
.22%
.38%
.82%
Mixed race
1.64%
2.24%
2.68%
Other race
1.09%
1.03%
4.79%
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Conduct a comprehensive assessment of staff and
organizational practices
What does your agency do or what do you do to
effectively work with and serve the diverse groups
in your community?
Do staff and the organization understand and
respect the cultures represented?
Are agency processes responsive to a variety of
cultures? (such as non-traditional families)
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Simple Self Assessment example:
http://www.healthystartpinellas.org/pdf/Self_Assess_5.pdf
http://www.asha.org/uploadedFiles/Cultural-Competence-Checklist-PersonalReflection.pdf
Extensive listing of Self-Assessment tools. University of Florida’s Intercultural Engagement
program.
http://iengage.multicultural.ufl.edu/resources/campus_resources/cultural_competence_reso
urces/
Competence Icebreakers, Exercises, Videos and Movies from Cultural and Linguistic
Competence Community of Practice, Technical Assistance Partnership July, 2012:
http://www.tapartnership.org/docs/CLC%20Icebreakers%20and%20Exercises%20%20FINAL%20(5).pdf
Community Tool Box, Building Competent Organizations
http://ctb.ku.edu/en/table-of-contents/culture/cultural-competence/culturallycompetent-organizations/main
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To learn about populations served or
underserved:
Develop & maintain partnerships with diverse constituency groups
 Immigrant service organizations
 Churches with services in non-English
 Ethnic markets
Have agency materials adapted to the cultural and linguistic
contexts of populations served
 Printed materials– not only language; appropriate for the literacy
level of families served
 Ethnic media - television, radio, Internet, newspapers,
periodicals)
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To improve service delivery:
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Evaluate participation and satisfaction rates of
families served from various cultures
Build capacity of provider network, do you have
culturally competent providers?
Build an advisory committee that has knowledge of
the groups served
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To provide supports for Non-English speaking
individuals:
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Recruitment of Bilingual/bicultural staff
Language interpretation services including distance
technologies (VRI: Video remote interpreting)
Use cultural brokers to confer with professionals
who are not skilled in, or knowledgeable of, a
client’s culture.
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To address staff training:
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Initial staff training: self-awareness activities and
knowledge focusing on cross-cultural
communication and language
Establish cultural competence as an on-going
learning process. This may include identifying the
need for increased funding!
Establish a brown-bag lunch series in which a
community member is invited to speak on a
culturally related topic of interest.
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At the Organizational level:
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Establish a goal to increase volunteers, student
practicum experiences, etc. to recruit a more
diverse staff
Establish performance measures that assess
cross-cultural knowledge and skills of the staff
group
More ideas to evaluate at the policy level; Source: Policy Brief 1Rationale for Cultural Competence in Primary Health Care
http://nccc.georgetown.edu/documents/Policy%20Brief%201%20Checklist.pdf
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Support Coordinator:
 Demonstrates an awareness of and respect for coworker
and consumer’s cultural background
 Assesses patient’s ability to communicate in English and
assists in the provision of an interpreter, as needed
Supervisor:
 Arranges for translation of relevant patient information
and materials and assures that the materials are culturally
appropriate
 Provides on-going training, supervision and evaluation of
staff on issues of cultural competence
Source: Lutheran Health Care
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Use SMART Goals
Specific
Measurable
Attainable
Reasonable
Time oriented
Review progress and revise as needed
Reassess and make needed adjustments; keep
learning!
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National Center for Cultural Competence
http://nccc.georgetown.edu/
Magellan Cultural Competency Resource Kit
https://www.magellanprovider.com/MHS/MGL/
education/culturalcompetency/resourcekit.pdf
Office of Minority Health, US Department of
Health & Human Services
http://www.minorityhealth.hhs.gov/
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Cultural Competence = Relationship Building
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INDIVIDUAL: Get to know yourself ( worldview, values,
uniqueness of others)
ORGANIZATION: Get to know your community
(traditions, cultures, norms, practices, beliefs) so your
agency can be more in tune with their assets and needs
SYSTEMS: Get to know your agency (culture, mission,
values, staff, services, policies, practices, philosophies)
so you can better serve the community
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Robyn Peyton, Case Management Director,
Developmental Disabilities Resource Board
Joanie Chenault, Director of Family &
Community Living Supports, Boone County
Family Resources
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