Cultural Competency: A Power Point Presentation

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3. CULTURAL COMPETENCY Cultural competence is a set of congruent behaviors, attitudes, and policies that come together as a system, agency, or among professionals and enable that system, agency, or professionals to work effectively in cross-cultural situations. The word culture is used because it implies the integrated pattern of human thoughts, communications, actions, customs, beliefs, values and institutions of a racial, ethnic, religious, or social group. The word competence is used because it implies having a capacity to function effectively. What else is Cultural Competency? Cultural competency is the ability to work effectively across cultures. For individuals, it is an approach to learning, communicating and working respectfully with people different from themselves. Culture can refer to an individual’s race, class, gender, sexual orientation, religion, immigration status and age, among other things. For organizations, cultural competency means creating the practices and policies that will make services more accessible to diverse populations, and that provide for appropriate and effective services in cross-cultural situations.

5. There are five important things to understand about culture: Everyone has a culture. It is core to their identity, behavior and perspectives on the way the world works and should be. In fact, everyone lives as part of multiple cultural spheres: ethnic, religious, class, gender, race, language, and others. Culture is not just the group a person is born into. It is possible to acquire a new culture by moving to a new country or region, for example, or by a change in economic status, or by becoming disabled. There is diversity within cultures. While two people may both be Latinos with parents from Mexico, for instance, a religious Catholic daughter of professionals who lived in Mexico City will have very different cultural norms and perspectives from the son of an indigenous farmer who spent early years in a very poor rural area. Cultures are not static. They grow and evolve in response to new circumstances, challenges and opportunities. The ways of being female learned by young girls in South Asian culture, for example, have changed from one generation to another, and as people have moved from place to place. Culture is not determinative. Different people take on and respond to the same cultural expectations in different ways. Assumptions therefore cannot be made about individuals based on a specific aspect of their cultural experience and identity. Cultural “differences” are complicated by differences in status and power between cultures. When one cultural group has more power and status, the norms of that culture permeate the institutions of society as the “right” way. Cultures of less status and power become seen as “other,” or even deviant and deficient. In addition to understanding cultural norms and experiences, service providers and professionals in agencies that work with diverse populations need to be aware of these kinds of cultural biases, both as they play out in the lives of communities, and as they affect the practices and policies of organizations.

6. Why is Cultural Competency Important? In the diverse communities of San Mateo and Santa Clara Counties, California, cultural competency has become a necessity for service providers, professionals and agencies. In the midst of an unprecedented demographic shift, there is no longer any single ethnic, racial or cultural group that constitutes a numerical majority. People from every corner of the globe live in these communities, and within the two counties more than 50 languages are spoken. Disproportionately, immigrants and people of color live in the poorest communities, attend the most overcrowded schools with the least trained teachers, and work the least-paid and least health-sustaining jobs. Marginalized groups are struggling with the effects of discrimination. There is great urgency for service and support organizations to reach these groups – and to be able to serve them effectively. To do so in a place as diverse as the Bay Area, every agency leader, staff member and provider needs to reach out to, learn about and connect with people who are different from themselves in some way – who don’t share their culture, racial experience, language, class background, religion, gender, nationality, and/or other experiences.

7. EXAMPLES OF THE NEED FOR CULTURAL COMPETENCE: 1. A young Guatemalan immigrant mother comes to pick up her 13-month-old daughter at an infant-toddler daycare program, and is distressed to find her child’s shoes are in the cubby, instead of on her feet. The last two times this happened, she had explicitly told the teacher she wanted her daughter to wear shoes. As before, the teacher explains that going barefoot is the best thing for a child who is learning to walk, and she doesn’t think stiff dressy shoes are appropriate attire for a toddler to wear to the program. The teacher is concerned about balance and physical control. What is the root of the conflict here?

8. The mother, on the other hand, is concerned about parasites in the soil – a common danger back in rural Guatemala – and how others might view her as ignorant if her child is not wearing shoes. The teacher feels the parent is refusing important information about healthy development; the mother feels the teacher is ignorant about environmental dangers and social stigma.

9. 2. A parenting series is held at a neighborhood school on the role of parents in supporting academic success. At the first session, the trainer emphasizes the importance of creating a separate, undisturbed quiet space for elementary school students to do their homework at night. She tells parents they should take their children to the library once a week, and read books to them in English each night. At the end of the session, each parent is asked to sign a “Parent Contract for Academic Success” attesting to their agreement to create supportive learning conditions at home. Two parents leave before signing the document, and never return. Why? (Answer follows)

10. One felt embarrassed, unable to imagine how, in the overcrowded apartment shared by three generations (9 people), a separate homework space could be arranged. Another felt heavy-hearted and ashamed because he never learned to read in his native Vietnamese, and is just beginning to learn English. The trainer is disappointed that attendance is dwindling and feels frustrated that some parents weren’t even willing to sign the agreement.

11. 3. On a hot afternoon, Kevin Jones, the athletic director in an after-school program, approaches a young Iranian girl, new to the program, who is sitting on a bench watching the relay race. Encouraging her participation, he tells her to “get into the game!” Shafiqa doesn’t move, and finally says: “I feel too weak. I’m fasting.” The counselor pauses, sure that the girl is on some kind of fad diet, and admonishes her for not eating. “Go inside and get something to eat – it’s stupid to go all day without nourishment.” Tears begin to drip down the girl’s cheek, and she whispers, “I can’t eat today. It’s my family. Please don’t make me run.” He recognizes a feeling of annoyance towards the family for not being sure Shafiqa had breakfast in the morning and a healthy lunch that day. Just then, Shafiqa’s friend rushes over and says: “Leave her alone. It’s Ramadan – it’s her religion. She has to fast.” Kevin feels embarrassed, apologizes to Shafiqa, and wonders why no one on the staff had alerted him. Perhaps they didn’t know either. He pledges to alert the other staff, to ask the parents for more information about Ramadan, and to remember in the future that Shafiqa (and perhaps others in the program) are Muslims and celebrate different holidays than he does as a Christian.

12. What Does Cultural Competency Look Like? Sara Watkins, a visiting RN, enters the home of a Laotian family, anxious to help the parents address the needs of their 3-year-old who has recently been released from the hospital after a bout with asthma. The nurse notices round abrasions on the child’s chest and trunk, and asks the parents how those abrasions occurred. The parents are silent, and Nurse Watkins considers the possibility of child abuse. Ready to fill out a report to Child Protective Services, the nurse recalls that a community healer, who had addressed the staff at the home nursing agency, had talked about “coining,” a healing approach used in many Laotian families. At the time, the nurse had recoiled at the description of applying hot coins to a child’s skin, though she had also reminded herself that some Western medicine healing approaches might appear strange and unnecessarily painful to people from other cultures. She had made a mental note to find out more information about “coining,” but hadn’t gotten around to doing so. Today, she makes a call to a friend in the Laotian community to help identify a community healer she might talk with, and to ask for assistance in communicating with the family about healing practices.

13. Kevin Jones and Sara Watkins are both working at being culturally competent. For individuals, this involves ongoing learning – about one’s own responses and about the cultures of others – and then changing responses to situations based on that learning. Central to this is to become aware of one’s own culture, position in society, and assumptions. This may be through learning family history, reading about the history of one’s heritage, and observing carefully what kinds of things seem natural and what seems “different” or “uncomfortable.” Often, it is the moments when a person is tempted to judge negatively the behaviors of people who are different from them that provide clues to their own cultural assumptions or biases. In addition to learning about one’s own culture, it also is important to learn about the history of different cultural groups in the communities served; where they came from, when they came, and why they came – by asking people, by reading, by seeking out community events. And it is important to learn about the history and dynamics of power that have shaped and continue to affect the relationships between cultural groups – both within organizations and in the broader society. Key to all this is developing the skills of listening carefully, observing without judgment, and recognizing that one person’s way of doing things is not the only way – or the best way – it can be done. Attitudes that contribute toward cultural competency also include empathy, comfort with differences, self awareness and reflectiveness, flexibility, and an appreciation of multiple perspectives.

14. UNDERSTANDING OTHERS “To look through my eyes is to see my perceptions; to see my perceptions is to understand me better; and to understand me better is to be able to communicate more effectively with me, and then you and I will be able and willing to say what we need to say, honestly, and openly”. - Judge Lubbie Harper, Jr.

15. Monolingualism and the Sapir/Whorf Hypothesis “Our view of reality is circumscribed by our own language”. The native language determines how a person views the world and that we are unaware of our mental entrapment if we remain monolingual. Thus if we grow up speaking only our native tongue, we are never conscious of how thoroughly our ability to think is circumscribed by the way our language compels us to structure our thoughts. Just as a deep-sea creature would be unaware of the nature of water because he has never experienced non-water, a monolingual person is unaware of nature of his native language because he has had no significant contact with a foreign language. His ethnocentric mind set traps him into believing that his native language is the only reasonable way to express reality. All languages cause distortions by the way it structures expression.

16. SCENARIO: “An Englishman and a Hopi Indian walk into John’s hospital room and immediately become aware that John’s life is coming to an end”. They comment to themselves that: English: “John is dying”. Hopi Indians: “Dying is taking place in John”. The Hopi more accurately express the fact that John is really not doing anything, whereas the Englishman, by the very nature of how his language, English, symbolizes actions in the “real” world, is forced to attribute agent power to John even though John is passively, and perhaps unwillingly, taking part in the process of dying. Englishman: “John likes the food”. (Is John really doing anything to his food?) Spanish: “A Juan le gusta la comida”. Literal Translation: “The food pleases John”. The author, G.H. Fisher:  “We will never really penetrate the thinking of people from another country and their culture, until we have first penetrated the language which carries, reflects, and molds the thoughts and ideas of that people.”

17. ENGLISH VS. SPANISH SINGULAR PLURAL 1. I 1. We 2. You 2. You (all) 3. He 3. They She They You You (all) It They SINGULAR PLURAL 1. Yo 1. Nosotros 2. Tú / Vos 2. Vosotros 3. El 3. Ellos Ella Ellas Usted Ustedes Vuestra Merced Vd. Usted Ud. “You” comes from the Old English (450 AD to 1150 AD) word “Eow”, which was converted into “you” in Middle English (1066 AD to 1492 AD).

18. SOME FACTS TO CONSIDER ABOUT HISPANICS Many immigrants, in general, of diverse racial, ethnic and cultural heritage suffer disproportionately from cardiovascular disease, diabetes, HIV/AIDS, and cancer. Their infant mortality rates are generally higher. Their childhood immunization rates are lower. They have a disproportionate level of poverty and they probably lack health insurance, nor have they had proper health care up to this point. English is probably not their native language. Their limited proficiency in English doesn’t reflect their level of intelligence, however. The roles of the male and the female may differ from what we are accustomed to. Dominant male animal in the wild is________? They probably have different religious backgrounds and practices. Those practices may influence how they respond when interacting with you. The family unit may be defined differently in different cultures. Elderly family members are likely to live with their children.

19. Due to the high cost of purchasing textbooks and school materials in their country of origin, many immigrants may lack formal education beyond the primary level. The U.S. population is growing, it is older, and it is more diverse. As of May, 2007, the U.S. Census Bureau reported that 44,300,000 persons in U.S. were of Hispanic or Latino origin, or 14.8% of total U.S. population. They are now the largest U.S. minority group. 67% of the above Hispanic group originates from Mexico. In Indiana the percent of Hispanic population is 4.5%. By 2012, it is predicted that Hispanics will be 1 in every 5 U.S. population. By 2050, the total figure for the U.S. of Hispanic persons is estimated to grow to 103 million of the total U.S. population of 420 million, or 1 in every 4 persons. 28 million people living in the U.S. are of Mexican origin, of which 17.5 million were born here and another 10.6 million were born in Mexico, at least one half of which are estimated to be undocumented. 70% of that total population are young, between the ages of 15 and 44 years. 80% of which are male. Only 50% of them have reached 10th grade or less, and only 5% have gone beyond grade 10. 5.9 million lack health care and 3 million are at poverty level, or the equivalent of 26% of the Mexican immigrant population (10.6).

20. Hispanics are more geographically concentrated than non-Hispanic Whites. For example, Hispanics are more likely to reside in the West and in the South. Hispanics are more likely than non-Hispanic Whites to live inside inner cities or metropolitan areas. Hispanics are more likely than non-Hispanic Whites to be under the age of 18. Only two in every five Hispanics are foreign born. Hispanics live in family households that tend to be larger (5 or more) than those of non-Hispanic whites. More than two in every five Hispanics, aged 25 and older, have not graduated from high school. More than ¼ of Hispanics had earned less than a ninth grade education. Among Latinos 25 years or older, other Hispanics, Cubans, Puerto Ricans, and Central and South Americans were more likely to have at least graduated from high school than were Mexicans. Hispanics are much more likely than non-Hispanic whites to be unemployed in traditional jobs. Hispanics are more likely than non-Hispanic whites to work in service occupations.

21. They are twice as likely to be employed as operators and laborers than non-Hispanic whites. Hispanics workers earn less than non-Hispanic white workers. Hispanics are more likely than non-Hispanic whites to live in poverty. Currently more than 20% of children in the U.S. are born to immigrant parents, and it is projected that by, 2010, students of color will comprise 50% of children in public schools. “Hispanic” is NOT a race, rather an ethnic classification because there are many difference races within the Hispanic/Latino people. Not all Hispanics speak Spanish. It is a misconception that all Hispanics get along with each other.

22. Did you also know that….? Traditionally, the Hispanic family is a close-knit group and the most important social unit. The term familia usually goes beyond the nuclear family. The Hispanic "family unit" includes not only parents and children but also extended family. In most Hispanic families, the father is the head of the family, and the mother is responsible for the home. Individuals within a family have a moral responsibility to aid other members of the family experiencing financial problems, unemployment, poor health conditions, and other life issues. Hispanic families, in general, instill in their children the importance of honor, good manners, and respect for authority and the elderly. Spanish speakers tend toward formality in their treatment of one another. A firm handshake is a common practice between people as a greeting and for leave-taking. A hug and a light kiss on a cheek are also common greeting practices between women, and men and women who are close friends or family. The Spanish language provides forms of formal and non-formal address (different use of usted vs. tú for the pronoun you, polite and familiar commands, the use of titles of respect before people's first names such as Don or Doña). In non-formal settings, conversations between Spanish speakers are usually loud, fast, and adorned with animated gestures and body language to better convey points.

23. Hispanics usually give great importance to and place great value on looks and appearance as a sense of honor, dignity, and pride. Hispanics tend to be more relaxed and flexible about time and punctuality than Americans. For instance, people who are invited for an 8 a.m. event may not begin to arrive until 8:30 a.m. or later. Within the Hispanic community, not being on time is a socially acceptable behavior. In the Hispanic world, religion has traditionally played a significant role in daily activity. More than 90% of the Spanish-speaking world is Roman Catholic. In Hispanic countries, a light meal is served for breakfast. Lunch, referred to as el almuerzo, usually is the main meal of the day for Spanish-speakers. In the early evening, la merienda, a light snack of coffee and rolls or sandwiches, is served. This meal is often very informal and may be just for children. In the evening, often as late as 9:00 p.m., la cena, a small supper, concludes the day's meals. Especially when guests are present, the meal may be followed by the sobremesa, a time to linger and talk over coffee or perhaps an after-dinner drink. Be aware that the physical distance between Hispanics when holding a conversation is much closer than in other cultures. Among Hispanics, information is passed mostly by word of mouth.

24. How do we gain cultural competency? Through self-evaluation and perpetual adaptation. Cultural competency begins with an awareness of one’s own beliefs and practices, and recognition that people from other cultures may not share them. Incorporating activities and materials into programs that prompt practitioners to transcend their own cultural comfort levels and as a result will help them at all levels to communicate and develop more effectively. Gain knowledge about how your own culture influences you. Develop knowledge of other cultures that go beyond simplistic stereotypes and assessments. Ex: “They all look alike.” Work hard at changing prejudgments or biases you may have about a people’s cultural beliefs or customs. Take the first step toward opening communication and getting to know your client. Linguistic and cultural barriers can make communication difficult and can lead to misunderstandings and lack of interaction. Success in dealing with people from other cultures involves being open, honest, respectful, non-judgmental, willingness to listen and to learn. Build trust by letting people know that you are interested in what they have to say. It is important to promote mutual respect. Cultural competence is rooted in respect, validation, and openness toward someone with different social and cultural perceptions and expectations than your own. Don’t just tolerate people of different backgrounds, but consider their differences as strengths. Welcome and acknowledge outsiders, value them, and respect them. Put yourself in the shoes of your client. Don’t be threatened or defensive by cultural differences. Be aware of differences in values, in communication styles, spirituality, definitions of family, and be accepting of those differences. We need to learn from each other. We need to understand as much as possible, a client’s diverse culture; values, traditions, history, and institutions. As America becomes more culturally diverse and citizen’s skin colors begin to meld, the importance of recognizing sameness, rather than difference, becomes imperative.

25. WHAT TO DO and WHY Being culturally competent is not just political correctness. It’s good policy. Cultural knowledge should be institutionalized from the CEO on down the line. It cannot be just a policy written on a piece of paper for public consumption. Put into practice the changes your organization deems appropriate for its clientele. Contact members of your community who come from the culturally different populations in your community. Ask them for information and advice on being culturally aware as it pertains to them. Share cultural knowledge. Provide a service system that displays cultural sensitivity and competence. Hire and use staff members who truly are bilingual/bicultural. Have documents that you routinely use reproduced in the target languages of the cultures of your clientele. Do role play scenarios for training. Raise awareness within the workforce.

26. Having a diverse staff does not necessarily equate with being culturally competent. Enhance and expand your community communication practices. Have public forums for questions and answers. Publish an ongoing news column to educate all diverse communities with your role. Be fair in your dealings with the diverse group. Educate yourself on immigration law. Adapt when delivering services which reflect an understanding of diversity. Use qualified and capable interpreters, avoid using family members or friends as interpreters, never use young children to interpret, minimize the use of internet or telephone tanslations or interpreting services. Avoid literal translations of existing materials for it loses meaning outside of its cultural context. Try to learn at least a few key words of the target languages. Serve as a role model in promoting diversity. Actions speak louder than words.

27. All of us want to do the “right thing”, but what is right for some cultures is not right for others. Is it culturally accurate to say and implement the golden rule of treating people the way you want to be treated? How about finding out how members of other cultures hope to be treated and use that as a guideline? The first step in cultural competency is in acknowledging the fact that we don’t know enough about other cultures. Then we need to agree that different people have different experiences, viewpoints and stories, sometimes contradictory ones. Many newcomers and minorities share a “self-inflicted otherness”. The outsider is different and does not fit in, he/she is not like the rest of us. This “self-inflicted otherness” acts like an internal destroying agent to what the other person holds dear, that which shapes his identity and gives him the will to survive. They also share personal and collective trauma. They are almost always patronized and considered intellectually inferior or inadequate. Most of these people are survivors, all struggling to live a “normal” life in a divided community, some segments of which are more hostile towards them than others. By the time they come into contact with each one of us, they probably have already experienced discrimination at every stop on their way: the gas station, the school, the workplace, the restaurant, etc.

28. We need to recognize and admit that our society suffers from biases, stereotypes, prejudices, racism and institutional racism and work to end these injustices. Once we accept the above facts, then we need to seek knowledge from authentic sources. By consulting people from all the target communities and from authorities, we can hope to achieve cultural competency. Furthermore, we need to think of people as individuals and not as representatives of the cultures they come from. We should hire personnel from diverse cultures, but not as tokens of their cultures, rather for their skills and capacities.

29. Benefits of a Culturally Competent Organization Higher quality service Culturally appropriate service Workplace harmony Reduction of internal complaints Reduction of extremes of behavior Reduction of external complaints Reduction of external criticism of the organization Enhances organizational prestige Increased community satisfaction Increased community support Increased productivity Increased skill base of members Skills to anticipate public sensitivities Reduced external complaints reduces the handling costs of them Lowering anti-discrimination complaints reduces investigation costs, prevents stress and morale impacts Increased staff retention broadens the recruitment base of the organization Promotes social cohesion via inclusiveness Creates positive role models for the community Increased public confidence Demonstrated integrity of the organization

30. What is a Culturally Competent Organization? An example: An after-school program serves a diverse mix of children, and makes an attempt to build relationships across differences. The Arts Counselor, Mary Tompkins, pulls together a group of students and suggests making a mural depicting where families came from and “the wonderful stories” of how they came to the U.S. and California. She begins by modeling her own story of great-great grandparents migrating west in a covered wagon. The group of children – mostly African American, Mexican and Central American immigrants – is noticeably silent. Why won’t they share their stories, she wonders? Why are they so unwilling to participate? Fortunately, that afternoon is the monthly staff discussion that is regularly dedicated to exploring issues of culturally competent practices. Mary describes to the group what happened and asks for other perspectives on what might be going on. José, one of the Latino staff recently hired from the community, shares the fact that many of the immigrant students are undocumented and may be worried about disclosing this fact for fear of their parents being deported. Ed, an African American administrator in the program, shares his personal reaction of feeling the pain of his enslaved ancestors who were forcibly brought to this continent under brutal, inhuman conditions. They put their heads together and design a youth inquiry project through which the children will be able to identify stories from their communities they would like depicted in a mural, share those stories, and paint the wall together.

31. As for individuals, cultural competence at the organizational level is an ongoing process. A culturally competent organization is engaged in an intentional and continuous process of learning about and responding to the cultural contexts of the communities and people it serves. The work isn’t done in a day, and it is never really finished – but the leadership of a culturally competent agency (board, executive, and administration) makes it a priority to create the culture, policies, practices and attitudes that can work toward effectively and respectfully serving diverse populations. This requires: being intentional in recruitment and hiring to assemble a diverse staff and board; investing in professional development about issues of culture, cultural competence, diversity and equity; creating the structures, time and norms for productive dialogue; ensuring attention to cultural issues in outreach, programming and service delivery; and setting expectations that practices will be adapted to address the needs of the agency’s diverse constituents and clients.

32. “We are all part of a criminal justice system that is obligated to serve people from different walks of life; a system that is designed to redress breaches of society’s legal code without regard to a person’s racial, social, ethnic or economic status.” “As we promote diversity and cultural competence, we must also reject the argument that race or ethnicity is an excuse for crime. Color or ethnicity didn’t murder the store owner, or sell drugs on the corner next to the day-care center where mothers, who are trying to do the right thing, drop off their kids in the morning. Color or ethnicity didn’t hijack a car, steal a purse, or break into someone’s home. While social or environmental factors may play a role in the development of one’s character, the decision to commit a crime belongs to the person who made it.” Judge Lubbie Harper, Jr.

33. NEWSWEEK JUNE 12, 2006 “The genius of America’s success is that the United States is a rich country with many of the attributes of a scrappy, developing society. It is open, flexible and adventurous, often unmindful of history and tradition. Its people work hard, putting in longer hours than those in other rich countries. Much of this has to do with the history and culture of the society. A huge amount of it has to do with immigration, which keeps American constantly renewed by streams of hard-working people, desperate to succeed.” “No worker from a rich country can equal the energy of someone trying to move out of poverty.” “Nuestras raíces están aquí, pero por favor, hay que tener en cuenta que todo lo que somos, se debe a la madre patria porque fue ella quien nos ha formado.”

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