Cultural Competence: Can it be Taught
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Cultural Competence: Can it be Taught

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2. Keynote Overview. What is Cultural Competence?Culture vs. Race/EthnicityCompetence vs. SensitivityStages of Cultural Competence. 3. Keynote Overview. Why is it Important?Increased Ethnic Diversity; Ethnic Disparities in Health;Providers\' Background Different From Patient. 4. Keynote Overview.
Cultural Competence: Can it be Taught

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1. Cultural Competence: Can it be Taught? Barbara W. Sugland, M.P.H., Sc.D. Maternal & Child Health Institute: Addressing Health Disparities St. Paul, Minnesota June 27, 2002

2. 2 Keynote Overview What is Cultural Competence? Culture vs. Race/Ethnicity Competence vs. Sensitivity Stages of Cultural Competence

3. 3 Keynote Overview Why is it Important? Increased Ethnic Diversity; Ethnic Disparities in Health; Providers? Background Different From Patient

4. 4 Keynote Overview How to Achieve it? Organizational Transformation Personal Transformation

5. 5 What is Cultural Competence? Cultural Competence A set of congruent practices, skills, attitudes, policies and structures, which come together in a system, agency, or among professionals, which enable that system, agency or professionals to work effectively in cross-cultural situations.

6. 6 What is Cultural Competence? Cultural Competence Congruence across aspects of service delivery; Aspects of service include: Practices, skills, attitudes (Individual); Practices, policies, structures (Organization)

7. 7 Culture vs. Race/Ethnicity Culture Shared values, beliefs, traditions, norms, customs, folklore, art, history of a group of people A foundation ? ?grounds? you Passed on from generation to generation;

8. 8 Culture vs. Race/Ethnicity Culture Dynamic & evolving; Shapes attitudes & values; Shapes styles and modes of communication; Shapes notions about health & illness; Shapes health-seeking behavior.

9. 9 Culture vs. Race/Ethnicity Race Historically ascribed to groups of individuals categorized as biologically distinct. Modern Times ? ?race? is a social construction Physical, behavioral and cultural differences incorrectly ascribed to race;

10. 10 Culture vs. Race/Ethnicity Ethnicity A subgroup that shares common ancestry, geography, history, language or culture;

11. 11 Sensitivity vs. Competence Cultural Sensitivity Heightened awareness of cultural differences Increased ability to interpret and respond to non-verbal or cultural cues Willingness and ability to adapt behavior

12. 12 Sensitivity vs. Competence Cultural Competence Incorporate plans, policies & practices to respond to differences Cultural sensitivity is necessary but insufficient for achieving competence

13. 13 Stages of Cultural Competence

14. 14 Stages of Cultural Competence Destructiveness -- actively working to destroy or diminish well-being Incapacity -- not actively seeking to destroy, but not actively working to improve well-being Blindness -- unbiased treatment is the most effective treatment

15. 15 Stages of Cultural Competence Pre-Competence -- Belief, desire & commitment, not clear on how to move forward Competence -- Belief, desire & commitment + structure, systems & policies in place Advanced Competence -- Competence + Vocal advocates for competent care

16. 16 Progressing Toward Cultural Competence Conditions for Progress (Individual) Awareness Knowledge Skill Practice (cultural encounters) Personal will

17. 17 Progress Toward Cultural Competence Conditions for Progress (Organizational) Mission & values support competence Policies promote it Programs and services reflect it Hiring strategies facilitate diversity and competence Mechanisms of accountability to reward & sanction

18. 18 Models of Competence LIVE & LEARN (Carballeira, 1997) LIVE -- Like, Inquire, Visit, and Experience LEARN -- Listen, Evaluate, Acknowledge, Recommend, and Negotiate

19. 19 Models of Cultural Competence Sunrise (Leininger, 1993,1999) Stresses world view and social structure of client Several dimensions ? Cultural, religious & spiritual, economic, educational, technological, kinship & social, political/legal Providers must explore and validate what the patient says and does

20. 20 Why is Cultural Competence Important? Ethnic Disparities in Health Rates of disease & morbidity higher among racial/ethnic subgroups Some improvements ? gains modest and uneven

21. 21 Why is Cultural Competence Important? Increased Ethnic Diversity Non-whites ~ 31% of US Population Increase of 25% since 1990 Density of Ethnic Populations Providers? Background Different From Patient

22. 22 Why is Cultural Competence Important Context for Understanding and Responding to Differences Guidance for How to Connect with Patients; Framework for Enhancing Quality of Care

23. 23 Achieving Cultural Competence Achieving Competence Requires: Organizational Transformation Philosophy Structure, practices, protocols Partnership & collaboration Personal Transformation Notions about self relative to others Capacity (skills and proficiency) Courage

24. 24 Achieving Cultural Competence Practices of Successful Organizations: Define Culture Broadly Beyond ethnicity, heritage, language Shared attributes (gender, sexual orientation) Shared life experiences (violence, homelessness)

25. 25 Achieving Cultural Competence Practices of Successful Organizations: Value client?s cultural beliefs Genuine concern and respect Ability to learn about needs and challenges of community Willing to understand clients? life experiences

26. 26 Achieving Cultural Competence Practices of Successful Organizations: Recognize Communication is Complex Communication is more than shared language Language differs across cultures Linguistic variation within cultures Cultural variation within language Variation in literacy for all groups

27. 27 Achieving Cultural Competence Practices of Successful Organizations: Facilitate Exchange between Provider and Community Create a ?learning loop? Active Community Involvement Community Advisory Boards Community Volunteers, Lay Workers

28. 28 Achieving Cultural Competence Practices of Successful Organizations: Collaborate with Other Agencies Health & Educational Institutions Health & Social Service Health & CBO?s

29. 29 Achieving Cultural Competence Practices of Successful Organizations: Institutionalized Cultural Competence Mission & values support competence Hiring and job descriptions stipulate it Ongoing staff training & development Services & outreach reflect it Mechanism for accountability and feedback

30. 30 Achieving Cultural Competence Personal Transformation Know and Understand Culture (broadly) Value Diversity Seek Opportunities to Experience Culture

31. 31 Achieving Cultural Competence Personal Transformation Self-reflection and Self-examination Styles, Attitudes & Behaviors Limitations Biases

32. 32 Achieving Cultural Competence Start small, identify ?winnable battles? Organizational Agency mission, staff retreats, workshops Anonymous feedback from clients Anonymous feedback from staff Personal Attend diversity or healing racism workshop Ask clients and colleagues for feedback Clients and colleagues from different backgrounds

33. 33 Achieving Cultural Competence Organizational Identify partners and establish partnerships Explore ways to collaborate and support Personal Partner with colleagues Broaden network of co-workers and contacts Increase exposure to diverse groups

34. 34 Achieving Cultural Competence Lobby for change; Funding to deliver & sustain competence Flexibility in service delivery strategies Staff training and continuing education Professional memberships Academic institutions and training centers Research, Public Policy & Advocacy Organizations


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