4. CULTURAL SELF AWARENESS
KNOW THYSELF
The “heal thyself before healing others” is a
common philosophy understood by people
across the world and yet the quest for cultural
self awareness is not a simple process.
Becoming culturally aware of one’s self requires that
individuals become functionally aware of the degree
to which their own behavior is culturally conditioned
by the past experiences
David Hoopes and Margaret Pusch
5. DEFINING CULTURAL
SELF AWARENESS
David Hoopes and Margaret Pusch
define cultural conditioning as “how
learning provided by a cultural and/or
social group fits a growing child to
assure its survival”. They suggest
we are all culturally conditioned by
our past and present socialization
experiences with family, friends, role
models and teachers
David Hoopes and Margaret Pusch
6. DEFINING CULTURAL
SELF AWARENESS
We are also culturally conditioned by our
positive and negative interactions with
culturally similar and culturally different
people.
As a result of being culturally conditioned,
we form definitions of what we consider,
normal, acceptable and standard
behaviors, communication styles, cultural
values and patterns of thinking.
David Hoopes and Margaret Pusch
7. DEFINING CULTURAL SELF
AWARENESS: Cultural Conflict
H oopes suggest, “We assume that
everyone perceives and experiences the
world as members of our own particular
ethnic, racial or cultural groups. The way we
perceive the world, what we expect of it and
what we think about it is basic and ingrained.
It is buried so deep in our consciousness
that we continuously act and react without
thinking”.
David Hoopes and Margaret Pusch
9. DEFINING CULTURAL SELF AWARENESS
Cultural Conflict
A decided outcome of this cultural
conditioning is the tendency to recognize
the problem in others and deny it in
ourselves. The only way we come to grips
with and take significant steps toward
cultural self understanding is to become
fully engaged with our own perceptions,
behaviors and communication patterns.
David Hoopes and Margaret Pusch
10. DEFINING CULTURAL SELF
AWARENESS Cultural Conflict
The process of assessing one’s self and
culture enables one to break through the
intellectual barriers and defenses. This
enables one to be more aware and
knowledgeable of the degree to which his
or her perceptions and behaviors are
culturally conditioned. This in effect is
cultural self awareness.
David Hoopes and Margaret Pusch
11. DEFINING CULTURAL SELF AWARENESS
Cultural Conflict
Even for those who pursue it, cultural
self awareness is elusive.
No matter how skillful, how much we
experience and are conscious of the
cultural dimensions of human relations
and multicultural realities we are
imprisoned by our own limited
perception of reality.
David Hoopes and Margaret Pusch
13. Maslow’s Hierarchy of Needs
Self
Actualization
Level 5
Esteem
Level 4
Social
Level 3
Safety
Level 2
Physiological
Level 1
Level 1: air, water, food, shelter
Level 2: knowing one’s survival is not in jeopardy
Level 3: feeling accepted by others;and being part of one’s social environment
Level 4: Feeling significant, important, effectual and competent
Level 5: Growing and expanding one’s personal capability, feeling fulfilled
14. Definition of Culture
The word “Culture” is used because it
implies the integrated pattern of human
behavior that includes thoughts,
communications, actions, customs, beliefs,
values, and institutions of racial, ethnic,
religious, or social group.
15. Cultural Competence
Cultural Competence is a set of
congruent behaviors, attitudes, and
policies that come together in a
system, agency, or among
professionals that enable them to
work effectively in cross-cultural
situations.
16. Defining Cultural Competence
Culturally competent systems have the capacity
to expand on this knowledge and integrate it into
All aspects of organizational policies, structures,
Staffing, interventions, financing, and evaluation
of results.
Cultural competence is:
a developmental and dynamic process.
synonymous with quality.
a strategy for reducing disparities.
17. Linguistic Competence
Linguistic competency requires
organizational and provider capacity to
respond effectively to the health literacy
needs of the population served. The
organization must have policies,
structures, practices, procedures and
Dedicated resource to support the
capacity.
Goode, T. (2002). Promoting Cultural Diversity and Cultural Competency- Self Assessment Checklist for Personnel
Providing Services and Supports to Children with Disabilities & Special Health Care Needs, NCCC, GUCDC
20. “Even more than other areas of
health and medicine, the mental
health field is plagued by disparities
in the availability of and access to its
services. These disparities are viewed
readily through the lenses of racial
and cultural diversity, age, and
gender.”
Surgeon General David Satcher, M.D., Ph.D.
in Mental Health: A Report of the Surgeon
General (DHHS, 1999, p.vi.).
21. The Business Case for Providers
Title VI
MOA for Endorsed Providers
State Contracts
Accreditation
Community-wide expectation
Competitive marketplace
22. Rationale for Cultural Competence
Cultural Competence = Quality of Care
Cultural Competence = Disparity Reduction
Cultural Competence = Risk Management
Cultural Competence = Parity (within MH system)
Cultural Competence = Linguistic Competence
Cultural Competence = A Fundamental Social
Responsibility
23. Benefits of Cultural Competence in
Healthcare
Improved Health Outcomes
Maximal Use of Limited Resources
Increased Customer Retention and Access to Care
Increased Customer Recruitment Increased Customer Satisfaction
Provide Products and Services Consistent with Client Needs
Culturally Competent Management, Staff and Practitioners
(Adapted from American Association of Health Plans, Minority Management Program, 1997)
25. Demographic Characteristics of
Mecklenburg County
Female 50.2%
Male 49.8
Age
Under 5 8%
5 to 17 16%
18 to 65 65%
65+ 8%
Race
White 64%
African American 28%
Asian 3.5%
Multiracial 3.2%
Other 1.5%
Hispanic/Latino 8.7% (48% Mexican, 23% Central American)
Source: 2004 American Community Survey (www.census.gov)
26. Population Projections
Race/Ethnicity 1995 2050
White 73.6 52.8
Black 12.0 13.5
Hispanic/Latino 10.2 24.5
Asian 3.3 8.2
American Indian 0.7 0.9
27. Population Projections
Hispanics/Latinos are the fastest growing
ethnic group in the United States.
In the United States, the Hispanic
population is expected to increase 14.3% by
the year 2050.
By the year 2050, there will be
approximately 97 million Latinos in the
United States.
28. Race/Ethnicity: County and LME
Comparison
70
60
50
%
40
30
20
10
0
Hispanic White African American
Mecklenburg Co. LME
29. Definition of Disproportionate
Disproportionate representation refers to a
situation in which a particular racial/ethnic
group of children are represented in a system at
a higher or lower percentage than their
representation in the general population.
It can also serve to highlight:
underutilization of or access to services; and
disproportional rates of poor prevention
and child service outcomes
Adapted from the Casey Family Programs (2002).
30. Cultural Competence
Continuum
Cultural
Proficiency
Cultural
Competence
Cultural
Pre-Competence
Cultural
Blindness
Cultural
Incapacity
Cultural
Destructiveness
32. Some thoughts on Culture…..
If there is not the understanding that cultures
are different and that people have different
ways of responding to the basic realities of life
and economics and politics and love and
eating and a million things because of what
Their cultures have been, then we can’t
Understand each other.
- by Carlos Fuentes
33. Cultural Assessment
Cultural assessment of the consumer is an
important step in identifying the consumer’s views
and beliefs related to health and illness. Beliefs
About the cause, prevention, and treatment of illness
Vary among cultures. Such beliefs dictate the
Practices used to maintain health. Studies have
Classified Health (Mental) Practices into several
categories: folk practices, spiritual or psychic
Healing practices, and conventional medical
practices.
34. Concepts: Culture
.
Culture Reflects
Includes
Includes
Beliefs Experiences
Influences Influences
Includes Actions Economic
Includes
May
Goals Result
Social
Literature In Includes Relationship
s Political
Communication Educational
Views Styles
Of
Truth
Arts Persona
l
Habits
Social
Includes
Visual
Performing
Developed b LM Lopez, OMH, 1
35. Concepts: Beliefs
Beliefs
Include Influence
Views Of Truth Influence Values
May Focus
On Include
Human Include
Religion Nature Interpersonal
Relations
Focus Of Include
May May Be Human Activity
Include Considered
Supernatural Time
Beings Good Orientation
Relationship
God With Nature
Redeemable
May Be Perceived As
Bad
One Many
Developed by LM Lopez, OMH, 1995.
36. Concepts: Personal Habits
Personal
Include Include
Habits Dress and
Eating Appearance
Include
Involves Involves
May Influence
Table Food Health
Manners Include Practices
Hygiene Views Of
Includes Include Well-being
Affects
Preferences Influences May Include
Preparations
Healing
Methods
Practices Spiritual
Functions
Can Include May Be Physical
Traditional
Can Be Biomedical
Nourishment Emotional
Social
Developed by LM Lopez, OMH, 1995
37. Consumers strengths, needs and preferences
should drive the type and mix of services
provided, and should take into account the
development, gender, linguistic, or Cultural
aspects of providing and receiving services.
Providers should develop these individualized
plans in full partnership with consumers and
families, while understanding changes in
individual needs across the lifespan and the
obligation to review treatment plans regularly.
Source: Models, Principles and Values of Person /Family-Centered Planning, Neal Adams, MD MPH,Diane Grieder, M.Ed., Tom Nerney
38. Provider Competencies for
Direct Care Staff
Documentation of the person’s aspirations and goals
for an improved quality of life
Identify problems, needs and required interventions
Actively involve users, caregivers and families where
appropriate
Provide a comprehensive assessment of health and
social care needs (including caregivers and families
support needs)
Source: Models, Principles and Values of Person /Family-Centered Planning, Neal Adams, MD MPH,Diane Grieder, M.Ed., Tom Nerney
39. Competencies Cont’d
Regularly monitor review & systematically
evaluate service impacts and health gain
Identify the health and social care
resources required to meet the person’s
needs
Develop positive risk management
strategies and crisis prevention/response
plans
40. Benefits of Culturally Diverse Staff
Research indicates that when children and families are matched to
their therapist, service coordinator or clinician ethnically and
linguistically…
They are engaged in and complete their interventions more often
than those who are not
There is a reduction in premature termination of interventions,
which is common in many clinics serving ethnic minorities
populations and the poor
Children and families have the ability to express emotions and
feelings without having to explain themselves
Source: J.T Romero Operationalizing Cultural Competency:
Recruitment, retention and training of culturally diverse mental
health stff. (1996 June)
41. Benefits of Culturally Diverse Staff
Research indicates that when children and families
are matched to their therapist, service coordinator
or clinician ethnically and linguistically…
The use of their primary language in therapy provides them
with control of their internal cognitive processes, which is the
source of emotions. Thus children and families’ emotions are
not subject to “translation” by way of the effects of linguistic
translation, which can include intonation patterns, voice
volume, and gestures.
Allows clinician to assess the totality of the information the
child and family are providing
42. Provider Competencies for
Change Management
t Develop a strategic planning process
g Operationalize plan in a logic model
l Good data and research
s Racial/ethnic impact analyses of policies and programs
p Targeted training and technical assistance
43. Provider Competencies for
Change Management
6. Tools to support change
7. Adaptations of services and supports
8. Infrastructure
9. A powerfully framed message and an active
communications strategy
10. Champions, allies and coalition building
44. How Do We get There?
COMPETENCE
Cultural Insights, Inc
49. What are the next steps?
What policies, practices and strategies need to be
put into place at each provider agency?
In what ways can providers work together with the
LME to create technical assistance and resource
sharing opportunities?
REMEMBER: To avoid confusion, the terms “ Hispanic ” and “ Latino ” will be used interchangeably during this presentation.
Destructiveness-Represented by attitudes, policies and practices that are destructive to cultures and the individuals within the culture. For example: agencies, institutions that promote cultural genocide: US Chinese Exclusion Laws; and the KKK and other racial superiority groups. Incapacity--Supports segregation as desirable policy Enforces racial policies and maintains stereotypes Disproportionately applies resources. Discriminates on basis of whether people of color “know their place” Lacks the capacity or will to help minority participants and employees. System remains extremely biased, believes in the racial superiority of the dominant group. Maintains paternal posture toward “lesser races”. For example, lower expectations of minorities an subtle messages that they are not valued. Blindness--Color or culture makes no difference and that all people are the same Ignores cultural strengths Encourages assimilation; thus, those who don’t are isolated Blames victim for their problems. Views ethnic minorities as culturally deprived Pre-Competence--“What can we/ I do?” Desires to deliver quality services; commitment to civil rights. Realizes its weaknesses and attempts to improve some aspect of their service Explores how to better serve minority communities. Agency may believe that their accomplishments of one goal or activity fulfills their obligation to minority communities; may engage in token hiring practices Often only lacks information on possibilities on how to proceed. Competence--Acceptance and respect for difference. Expands cultural knowledge and resources. Continuous self-assessment.Pays attention to dynamics of difference to better meet client needs. Variety of adaptations of service models. Seeks advice and consultation from the minority community. Commits to policies that enhance services to diverse clientele. Proficiency--Holds culture in high esteem. Agency seeks to add to its knowledge base. Agency advocates continuously for cultural competence throughout the system.
Denise—includes beliefs, actions, and experiences, influences and may result in, and culture reflects our experiences. They influence all other areas of our lives… Also—experiences can reinforce beliefs, actions, etc…
Denise—like having a bag of beliefs and a bag of values that we carry with us. We need to understand people’s beliefs and values and how they affect how people think, feel, and interact. Especially in terms of service delivery. Jill—example—Native American views of truth…
Denise—now consider how all of the personal habits, beliefs, values make up the individuals that walk in the door seeking mental health services. All of these concepts come with them and we need to be aware of that in order to provide quality services. All health care is cultural—no right or wrong—just different—we need to see the individual that seeks care. CHECK CLIMATE