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Communication Across Cultures. Marian H. Jarrett, Ed.D. Lorelei Emma, M.A. George Washington University 6 th Annual Infant and Toddler Connection of Virginia Early Intervention Conference 2008.

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communication across cultures

Communication Across Cultures

Marian H. Jarrett, Ed.D.

Lorelei Emma, M.A.

George Washington University

6th Annual Infant and Toddler Connection of Virginia Early Intervention Conference 2008

slide2
Across cultures, people may differ in what they believe and understand about life and death, what they feel, what elicits those feelings, the perceived implications of those feelings, the ways they express those feelings, the appropriateness of certain feelings, and the techniques for dealing with feelings that cannot be directly expressed…To help effectively, we must overcome our presuppositions and struggle to understand people on their own terms. (Irish, Lundquist, & Nelson, 1993, p. 18)
agenda
Agenda
  • Introductions
  • Part 1: Grieving Process
  • Part 2: Communication
  • Part 3: Case Scenario Discussion
  • Part 4: Questions and Group Discussion
children and families and culture
Children and Families and Culture
  • Family adjustment seen in context of family systems and ecological model
grief is a normal response to an abnormal situation
Grief is a normal response to an abnormal situation
  • Grieve the loss of the expected child
  • Pregnancy images of the imagined child
  • Process of grieving and adaptation is complex and confusing for family
  • Grief does not signal non-acceptance or devaluing of the family member
grief a complex personal experience
Grief: A Complex, Personal Experience
  • No typical time; some suggest 1-3 years
  • Varies greatly from individual to individual
  • How person copes depends on previous coping behaviors
  • Grief for a disability may become more intense during periods of transition
secondary losses compound initial grief reactions
Secondary Losses Compound Initial Grief Reactions
  • Families experience stress as secondary losses when needs are not met
  • Secondary losses may challenge a family’s ability to manage grief
    • Services should be family-centered, relationship-based, and culturally competent
    • Consider the impact of respite services, in-home medical support and therapy, financial assistance, and family support for this particular family
predominant phases of grief
Predominant Phases of Grief
  • Traumatic Stress or Shock
  • Assimilation
  • Acknowledgment and Integration
  • Phases recycle and blend into one another
  • Certain feelings predominate in each phase
phase 1 traumatic stress
Phase 1: Traumatic Stress
  • Period immediately following diagnosis
  • Numbness, shock, disturbed sleep, panic, and despair
  • Families
    • Make major decisions about treatment and services
    • Report do not hear what doctors and service providers say
    • Try to understand meaning of diagnosis
    • May experience relief with diagnosis
feelings behaviors in initial phase
Feelings & Behaviors in Initial Phase
  • Gather as much information as possible
  • Express anger at doctors and diagnosis
  • Tearful and withdrawn
  • Preoccupation with imagined child
  • Panic and helplessness
  • Focused on immediate needs
  • Frightening for siblings
phase 2 assimilation
Phase 2: Assimilation
  • Confusion begins to dissipate
    • Sharper realization of nature and extent of disability
  • Family members show highly idiosyncratic, changing responses
  • Heavily influenced by personality and contextual factors
  • Period when families experience their most intense reactions to loss of hoped-for child
feelings in assimilation phase
Feelings in Assimilation Phase
  • Hope
  • Anxiety and restlessness
  • Depression and anxiety
  • Guilt
  • Anger
  • Social Isolation
phase 3 acknowledgment and integration
Phase 3: Acknowledgment and Integration
  • Greater understanding and acknowledgment of disability
  • Greater integration of child with a disability into the family
  • Periods of distress are briefer, less intense
  • Parents still report “having a bad day”
behaviors and feelings in integration phase
Behaviors and Feelings in Integration Phase
  • With help, family members can
    • acknowledge they are feeling better
    • distinguish grief-related stress from other stress
  • Acknowledge there is no “getting back to normal.” Families are forever changed.
  • Begin to see self as a parent, not just a parent of a child with a disability
  • Embed learning into daily routines
cultural competence in supporting families who are grieving
Cultural Competence in Supporting Families Who Are Grieving
  • Definition:
    • A set of values, behaviors, attitudes, and practices within a system, organization, program or among individuals and which enables them to work effectively cross culturally.
    • Ability to honor and respect the beliefs, language, interpersonal styles and behaviors of individuals and families receiving services, as well as staff who are providing such services.

(Division of Services for Children with Special Health Care Needs, 2005)

cultural competence as a process
Cultural Competence as a Process
  • Cultural competence is not an end-state, but a process:
    • Encompasses not only cultural knowledge on the part of the service provider, but also constructive attitudes and attention to the total context of the family’s situation.
barriers to culturally competent care
Barriers to Culturally Competent Care
  • Institutional Barriers
    • Lack of diversity in health care’s leadership and workforce
    • Systems of care poorly designed to meet the needs of diverse patient populations
    • Poor communication between providers and patients of different racial, ethnic, or cultural backgrounds
  • Personal Barriers

Betancourt, Green, & Carrillo, 2003

development of cultural competence
Development of Cultural Competence
  • 3 Step Process (Iterative, No endpoint)

1. Clarification of the service provider’s own values, attitudes and assumptions

2. Knowledge of commonly held cultural beliefs and the culturally normative interactive styles of specific cultural groups

3. Skills that enable the individual to engage in successful interactions

AAP, 1999; Lynch & Hanson, 2004

self awareness activity
Self-Awareness Activity
  • Understanding Our Own Place on the Continua
    • Interdependence……Independence
    • Kinship (extended family)……Nuclear family
    • High context……Low context
    • Religious orientation……Secular Orientation
    • Authoritarian child-rearing……Permissive childrearing
    • Greater respect for older family members……Greater emphasis on youth
    • Oriented to the situation…….Oriented towards time
disability death and culture
Disability, Death, and Culture
  • When individuals are confronted with the fear and senselessness of disability, illness, and death, culture can:
    • Provide meaning for those who are grieving through its beliefs about life after death
    • Define care of the body after death and burial or cremation practices
    • Describe roles for grieving family members and for the community which surrounds them
    • Influence how grief is expressed
    • Affect how grieving families interact and communicate with caregivers
    • Impact how families approach decisions about interventions, treatment, and end-of-life decisions
beliefs and values influence grieving process
Beliefs and Values Influence Grieving Process
  • Beliefs about
    • disability and infant death
    • medical care
  • Values of
    • Family
    • Religion
    • Education
    • Age
influence of other factors
Influence of Other Factors
  • Age
  • Gender
  • SES
  • Education
  • Length of time in the US
  • Level of acculturation
communication
Communication

10.5 million U.S. residents speak little or no English

Different languages = difficulty communicating

Even with same language, language of disability and grief are always difficult.

(U.S. Census Bureau, 2001)

effective communication
Effective Communication

Medium through which families and providers negotiate the process of caring for an infant or young child with disabilities or a life-threatening illness

Basic tool used to establish and maintain relationships with families

Essential to family-centered and culturally-sensitive care

fostering shared meaning and mutual understanding
Fostering Shared Meaning and Mutual Understanding

Shows interest and encourages parent to continue

Uses open-ended questions to help parents describe their perceptions and feelings

Uses focused questions to gain specific information

Paraphrases the content of parent communication

Validates parent’s feelings

Remains nonjudgmental

examining our own communication
Examining Our Own Communication

Unconsciously learned ways to think, feel, and act according to what our culture considers appropriate

Often unable to set aside our own cultural values and listen to the family

May unwittingly violate cultural assumptions about the parent’s role, cause of disability, or intervention options

examining your own cultural values beliefs and practices
Examining Your Own Cultural Values, Beliefs, and Practices

Complete the Values Clarification Exercise in the back of your packet.

Read each statement, rate it, and move to the next statement.

There are no right or wrong answers.

values clarification exercise
Values Clarification Exercise

Review your responses.

Examine each statement by asking:

  • Why do I feel this way?
  • How might this affect my interactions with children and families?
social organization
Social Organization

Who are the members of the family system?

Who is the spokesperson?

Who should be included in discussions?

Is full disclosure acceptable?

Who makes decisions in the family?

showing respect
Showing Respect

Can be based on age, gender, social position, education, economic status and authority

Formality of communication shows respect

Distinct lines drawn between members of society in some cultures can impeded open communication

communication style
Communication Style
  • Low context culture – European American
    • Direct, precise, logical verbal communication
  • High context culture – Hispanic, Asian, African American, Native American
    • More informal
    • Rely more on situational cues
    • Non-confrontational responses
    • Well-established hierarchies
    • Physical cues and relationships are easily perceived
high context cultures
High Context Cultures

May be inappropriate to ask informally about family and disability or medical issues

Coming directly to decision-making may seem rude or insensitive

Direct confrontation and questioning may cause discomfort and even shame

revert to what is comfortable
Revert to What is Comfortable
  • Low context communicators may:
    • Talk less
    • Speak faster
    • Raise the volume of their voice
  • High context communicators may:
    • Say less
    • Make less eye contact
    • Withdraw from the interaction
providers must adapt their communication style
Providers Must Adapt Their Communication Style

Slow down and talk less

Look for meaning in physical gestures

Focus on the context of the family and the interaction

Be aware of hierarchical differences within families and between the family and the provider

cultural blind spot syndrome
Cultural Blind Spot Syndrome

Low socioeconomic status

Inexperience with Western health care and education system

Lack of or limited formal education

Emigration from a rural area

Little knowledge of English

Recent immigration to the U.S. at an older age

Segregation in an ethnic subculture

(Buchwald, et al., 1994)

l e a r n
L-E-A-R-N

Listen with sympathy and understanding to the family’s perception of the problem

Explain your perceptions of the problem

Acknowledge and discuss the differences and similarities

Recommend intervention

Negotiate agreement

guidelines for cross cultural nonverbal communication
Guidelines for Cross-Cultural Nonverbal Communication
  • Eyecontact – can be sign of disrespect, hostility or rudeness
    • Observe family members and members of cultural groups
  • Body language and facial expressions – may be interpreted differently
    • Ask for clarification of concerns, check for questions, or reword information being presented
  • Silence – some comfortable with long silences; some speak immediately
    • Listen to conversations between members of the same culture to learn the use of pauses and interruptions
    • Silence can have many meanings difficult to assess
guidelines cont d
Guidelines cont’d
  • Distance – preferred distance is 2-3 feet in U.S.
    • Give family members a choice of where to sit
    • Stand with room for parents to move closer or farther away
  • Touch – norms for how and when to touch
    • Touching not common for South Asians and West Indians
    • In some Latino cultures, touching conveys lack of respect, especially older people
recommendations to facilitate communication
Recommendations to Facilitate Communication

Encourage open dialogue by asking about family relationships, values and beliefs.

Informally determine fluency of family by asking open-ended question.

Encourage family to ask questions.

Ask family questions to check understanding.

Summarize what the parent says.

Do not discourage family from talking among themselves in their own language.

recommendations to facilitate communication1
Recommendations to Facilitate Communication

Work with cultural mediators.

Learn and use words and forms of greeting.

Provide information in different forms – oral, written, pictorial, demonstration.

Rely on the interpreter, observations, instincts, and knowledge to know when to proceed and when to wait.

working with an interpreter
Working with an Interpreter

Use trained interpreters for important meetings with the family.

Allow additional time to determine cultural values, beliefs and perspectives.

Reinforce verbal interaction with material written in family’s language.

Provide an interpreter when requested by the family even if they speak some English.

case scenario
Case Scenario

Overview of case

Small group discussion

Sharing out with whole group

references
References

Buchwald, D. Panagiota, V.C., Francesca, G., Hardt, E.J., Johnson, T.M., Muecke, M.A. & Putsch, R.W. (1994). Caring for patients in a multicultural society. Patient Care, June 15, 1994, 105-123.

Lynch, E.W. & Hanson, M.J. (2004). Developing cross-cultural competence: A guide for working with children and families. (3rd Ed.) Baltimore: Paul H. Brookes Publishing Co., Inc.

Montgomery, W. (2001). Creating culturally responsive, inclusive classrooms. Teaching Exceptional Children, 33(4), pp. 4-9.

U.S. Census Bureau. (2002). Number of foreign-born up 57 percent since 1990, according to Census 2000. Retrieved July 12, 2004, from http://www.census.gov/Press-Release/www/2002/cb02cn117.htm

contact information
Contact Information
  • Please feel free to contact either presenter with questions, comments, request for further information/resources, or to provide them with additional information/resources:
  • Marian Jarrett: mjarrett@gwu.edu
  • Lorelei Emma: loreemma@gwu.edu