A Child Life Approach to Cultural Diversity in the Health Care Setting

1. A Child Life Approach to Cultural Diversity in the Health Care Setting Rechelle D. Porter, LSW, CCLS Morgan Stanley Children’s Hospital of NY-Presbyterian Manhattan, NY Ayana M. West-Hewitt, MA, MSW CCLS Children’s Specialized Hospital New Brunswick, NJ September 15, 2012

2. Introduction • Ice breaker activity • Connect the Dots

3. Race • “Refers to a population considered distinct from others for certain outward, physical characteristics” (Rue, D. S. and Xie, Y., 2009, p. 154)

4. Culture • “Defined as a group of people’s shared patterns of belief, feelings, and knowledge that ultimately guide everyone’s conduct and definition of reality” (Rue, D. S. and Xie, Y., 2009, p. 154)

5. Ethnicity • “Is a term representing social groups with a shared history, sense of identity, geography and cultural groups” (Rue, D. S. and Xie, Y., 2009, p. 154)

6. Racial and Ethnic Minorities • “Racial and ethnic minorities in the United States include “blacks, American Indians, Hispanics, Asians, Pacific Islanders, and people of mixed races” (Rue, D. S. and Xie, Y., 2009, p. 154)

7. Cultural Competence • Goes further than general terms such as cultural awareness or sensitivity “because the individual and organization not only possesses cultural knowledge and respect but can apply that knowledge effectively in cross-cultural situations to improve the delivery of health services” (Barone, T. L., 2010, p. 454)

8. Why Cultural Competency in HealthCare? • In the U.S. the population is becoming more diverse • Helps to reduce racial and ethnic health disparities • Improves the quality of service and service outcomes • Attracting a diverse population can increase organizational revenue

9. “Culture influenceshow people interpret their illness” (Rue, D. S. and Xie, Y., 2009, p. 157)

10. Client’s Cultural Perceptions of Disparities within HealthCare • Lack of trust of the healthcare system • Stigma • Trust and treatment receptiveness • Alternative cultural interventions and/or treatment • Religious beliefs that might affect clinical care • Family decision-making process

11. Explanations for Disparities • Research has proven that healthcare clinicians have demonstrated bias stereotyping which all contribute to unequal treatment • Many healthcare clinicians are not educated on cultural competence in school (Hobgood, C., Sawning, S., Bowen, J., and Savage, K., 2006)

12. Explanations for Disparities Continued • Weinick, Byron, Han, French, and Scholle (2010) surveyed 22 practices from California and New Jersey and found the following: • A third of the physicians felt less skillful when working with different cultures other than their own • Some physicians see caring for racial and ethnic minority patients as very challenging

13. Case Example • A study was done in Eastern Massachusetts on cultural disparity of 6,814 adult diabetic patients. There were 90 physicians who needed to see 5 white and 5 black patients in order to be in the study. Findings proved that there was racial disparity within physician effects. The research demonstrated a strong possibility that unconsciously but surely innocently, clinicians can impose both individual and institutional ethnocentrism, not like the obvious racism of years past, while treating minority patients, even in 2011. (Rue, D.S. and Xie, Y., 2009, p. 160-161)

14. Explanations for Disparities Continued • Inadequate representation of population served • Clinicians from different ethnic and socioeconomic backgrounds • Frustration and Pervasive thinking • Conflicting viewpoints and restrictive relationships (McPhatter and Ganaway, 2003)

15. What Do We Do?

16. Individual BarriersSelf ReflectionPre-conceived NotionsUncomfortable and EmbarrassedAsking Questions

17. Asking Questions • 1. What is your cultural background ? • 2. Do you ever feel your cultural background effects the way you receive healthcare? • 3. How would you define your religious or spiritual beliefs ? • 4. How does your religious or spiritual beliefs affect the way you view your child’s illness? • 5. How would you like healthcare workers to respond to your cultural and spiritual needs?

18. Individual Barriers & Self Reflection • 1. What cultural group do you mostly identify with? • 2. Has there ever been a time that you felt different or discriminated against for being a member of this group? • 3. How can you use this experience to increase your empathy for a diverse group? • 4. How does it feel when someone assumes something about me without asking? • 5. How do I react towards others who have a different point of view than me?

19. Responses • Asian Indian Female • Puerto Rican Female • Ecuadorian-American Female • Rural-Class White Female • Jamaican-American Male

20. Case Study #1 • A 7 year old Jordanian boy admitted to acute care hospital for oncology treatment. On arrival patient is non-responsive and admitted to intensive care. Patients’ health status declined and was no longer eligible for treatment due worsening medical condition. Physician’s approached family regarding DNR/DNI. Parents refused to sign DNR/DNI.

21. Case Study #2 • A 8 year old Fulani boy with sickle cell disease admitted for sickle cell crisis. Mom is always present at bedside. She appears to be quiet and reserved. During patient care rounds mom does not ask questions. Medical staff is concerned if mom understands what happening with child. Patient is scheduled for bone marrow transplant. Staff is concerned how family will do during transplant.

22. What do we want to know about the family… • Support System • To whom do you turn to for help? • Does the patient have any siblings? • Culture • What are the families cultural values related to illness and death? • Ethnicity • What is the families ethnicity? • Religion • What are the families spiritual and/or religious beliefs?

23. Cultural Assessment Care plans for patients and families should include: • Child’s development • Coping style • Spirituality • Family needs • Social supports

24. How Culturally Competent Am I? • Pre contemplation • Individuals lack awareness of a need for change • Contemplation • Individuals or organizations are aware that a need exists and may be giving serious consideration • Preparation • Participants express clear intentions to change and make efforts • Activities in this stage are in the planning mode • Action • Participants’ expressed commitment to change turns into observable activities • Maintenance • Participants incorporate actions and behavioral change into normal individual or organizational patterns (McPhatter and Ganaway, 2003)

25. Other Approaches to Cultural Competence • Educatingstaff and students • In-services/Presentations • Annual cultural competencies • Guest speakers from community organizations • Facilities/institutions should create policies and/or standards for all staff and volunteers • Senior leadership • Clear and concise communication • Recruitment of cultural diverse staff members

26. “If healthcare providers can gain an appreciation for intercultural and intracultural variation, they can move away from cultural “cookbooks” and towards a receptive frame of mind for respectfully elicit and individual patients relevant beliefs to facilitate a positive treatment outcome” (Barone, T. L., 2010, p. 462)

27. Thank you!Questions

28. References • Barone, T. L. (2010). Culturally sensitive care 1969-2000: The Indian Chicano health center. Qualitative Health Research, 20(4). Retrieved from http://qhr.sagepub.com/content/20/4/453.abstract • Child Life Council. (2010). Child Life: empowering children and families to cope with life’s challenges. Retrieved from http://childlife.org/files/AboutChildLife.pdf • Gupta, V. B. (2010). Curbside Consultation: Improving sensitivity to patients from other cultures. Journal of the American Academy of Family Physician, 82(1). Retrieved from http://www.aafp.org/online/en/home/publications/journals/afp.html • Hobgood, C. Sawning, S., Bowen, J., and Savage, K. (2006). Teaching culturally appropriate care: A review of educational models and methods. Academy of Emergency Medicine, 13(12). Retrieved from http://onlinelibrary.wiley.com/doi/10.1197/j.aem.2006.07.031/pdf • Ingram, P. D. (2008). Diversity activity for youth and adults: connect the dots. Retrieved from http://pubs.cas.psu.edu/freepubs/pdfs/ui335.pdf • McPhatter, A. R. and Ganaway, T. C. (2003). Beyond the Rhetoric: Strategies for Implementing Culturally Effective Practice with Children, Families, and Communities. Child Welfare, 82(2). Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12699278 • Pulido, Laura. (2000). Rethinking Environmental Racism: White Privilege and Urban Development in Southern California. Annals of the Association of American Geographers, 90(1). Retrieved from http://www.geo.hunter.cuny.edu/courses/geog347/articles/rethinking_california.pdf • Rue, D. S. and Xie, Y. (2009). Disparities in treating culturally diverse children and adolescents. Psychiatric Clinics of North America, 32(1). Retrieved from http://www.psych.theclinics.com/article/S0193-953X(08)00108-1/abstract