An introduction to key concepts in cultural and linguistic competence and laws and policies that are connected with these concepts.

1. DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
“Policy in Action”
Planning for Culturally and
Linguistically Appropriate
Services in Human Services
Cecily Rodriguez
Office of Cultural & Linguistic Competence

2. DBDHS
Virginia Department of
Behavioral Health and
Developmental Services
Topics
• Common understanding of the terms
• Why is CLC in health & human services
important?
• CLC Planning and Policy Development
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3. DBDHS
Virginia Department of
Behavioral Health and
Developmental Services
A COMMON FRAMEWORK
What is culture?
Office of Cultural and Linguistic Competency - DBHDS
Page 3

4. DBDHS
Virginia Department of
Behavioral Health and
Developmental Services
Rethinking Culture
Office of Cultural and Linguistic Competency - DBHDS
Page 4

5. DBDHS
Virginia Department of
Behavioral Health and
Developmental Services
Dimensions of Culture
Page 5

6. DBDHS
Virginia Department of
Behavioral Health and
Developmental Services
Is Culture an Iceberg?
RACE
GOVERNING
CHILD-RAISING
VISIBLE
ATTITUDE
TOWARDS ANIMALS
LANGUAGE
CONCEPTS OF
HUMOR
DEFINITION
OF SIN
AGE
CULTURAL
ARTIFACTS
(CLOTHING, HAIRSTYLE, ETC)
Culture is Not an Iceberg – Milton J. Bennett PhD. 2013
HIDDEN
Don’t forget to adjust for
acculturation, generational
differences and other6 variables
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7. DBDHS
Virginia Department of
Behavioral Health and
Developmental Services
ROCCO
RODRIGUEZ
and the
Iceberg
Effect
Office of Cultural and Linguistic Competency - DBHDS
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8. DBDHS
Virginia Department of
Behavioral Health and
Developmental Services
What is Cultural Competence
National Center for Cultural Competence
Value
Diversity
Conduct
Self
Assessment
Manage the
Dynamics of
difference
Acquire and
institutionali
ze cultural
knowledge
Adapt to
the cultural
contexts of
your
community
And incorporate the above in all aspects of policy making, administration, practice,
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service delivery and involve systematically consumers, key stakeholders and

9. DBDHS
Virginia Department of
Behavioral Health and
Developmental Services
Levels of Cultural Competency
Individual Level
Right skills, knowledge,
and attitude to work
for a diverse
population
Organizational Systems
Policies and procedures in
place and an infrastructure
that supports diverse
communities
System’s Levels
Laws and regulations in place and an
infrastructure that supports diverse
communities
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10. DBDHS
Virginia Department of
Behavioral Health and
Developmental Services
What is Linguistic Competence?
The capacity of an organization
and its personnel to communicate
effectively, and convey information
in a manner that is easily
understood by diverse audiences
including persons of limited English
proficiency, those who have low
literacy skills or are not literate,
and individuals with disabilities.
National Center for Cultural Competence
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11. DBDHS
Virginia Department of
Behavioral Health and
Developmental Services
The Case for CLC
Disparities in Access and Outcomes
Mental Health: Culture, Race, Ethnicity Supplement to Mental Health: Report
of the Surgeon General
Minority populations have a disproportionate burden of death
and disability. Research has proven that communities of
color don’t access services in proportion to the white
community and their outcomes are less successful than
that of the white community.
• Documented disparities for people of color include:
– Less availability and access to services
– Lower likelihood of receiving services
– Greater likelihood of receiving poorer quality of care and disproportionate
treatment outcomes
– Over represented in hospitalizations (more restrictive settings)
– Under represented in research
2001
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12. DBDHS
Virginia Department of
Behavioral Health and
Developmental Services
The Case for CLC
•
Over 350 languages are spoken in the
U.S.
•
More women in the workplace than ever
•
There are more than 47 million people in
the nation who speak a language other
than English, and over 30 million who
were born outside the United States
•
During the past decade, the number of
Spanish and Asian-language speakers
grew by 50%
•
Over 17% of the nation’s population
speak a language other than English at
home.
•
Range of ages in the workplace
•
New workforce tends to be more
culturally diverse
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13. DBDHS
Virginia Department of
Behavioral Health and
Developmental Services
The Case for CLC
FEDERAL LAW
Civil Rights Act of 1964
The Civil Rights Act of 1964 says that no person
shall be excluded from participation in, be
denied the benefits of, or be subjected to
discrimination based on race, gender, ethnicity
or national origin under any program or activity
receiving Federal financial assistance."
Four factor analysis video clip - Presidential Executive Order 13166
http://www.lep.gov/13166/eo13166.html
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14. DBDHS
Virginia Department of
Behavioral Health and
Developmental Services
The Case for CLC
Title VI - “Meaningful Access”
Organizations are required to take reasonable steps to
ensure meaningful access to their programs and
activities by LEP persons. The Guidance explains
that the obligation to provide meaningful access is
fact-dependent and starts with an individualized
assessment that balances four factors:
1.
2.
3.
4.
Number or Proportion of LEP Individuals
Frequency of Contact With the Program
Nature and Importance of the Program
Resources Available
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15. DBDHS
Virginia Department of
Behavioral Health and
Developmental Services
The Case for CLC
Inova Health System Fairfax – $145,000
settlement for failure to provide signlanguage interpreting for parents of a
newborn with medical complications.
Maryland Department of Health and
Mental Hygiene DOJ required periodic
language needs assessments to ensure
all populations were considered in
services.
DBHDS investigation into allegations of
discrimination based on national origin.
As a result, language policy and
procedures were developed.
US Dept. of Justice
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16. DBDHS
Virginia Department of
Behavioral Health and
Developmental Services
Challenges To Cultural Competence
Individual challenges
•
•
•
•
Lack of self awareness of bias and value systems
Unclear connection b/w bias and decision making
Individual “isms”
Cultural blindness
•
Ethnocentrism
Organizational challenges
•
•
•
•
•
•
•
Lack of valid performance measures
Operationalization of CLC
Competing priorities
Systemic “isms”
Budget constraints
Regulatory ambiguousness
Staff turnover
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17. DBDHS
Models for Culturally and
Linguistically Appropriate Services
Patient centeredness,
cultural competence
and healthcare
quality – Saha,
Beach, & Cooper,
2010.
Standards for Culturally & Linguistically Appropriate Services 2013
Agency for Healthcare Research and
Quality (AHRQ)
Commission on Accreditation of
Rehabilitation Facilities
Virginia Department of
Behavioral Health and
Developmental Services
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18. DBDHS
Virginia Department of
Behavioral Health and
Developmental Services
Organizational Planning
Any plan should
address the six
critical domains
related to
cultural and
linguistic
competence.
Technical Assistance Partnership
www.tapartnership.org/docs/clcPlanTemplateFinal.doc
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19. DBDHS
Virginia Department of
Behavioral Health and
Developmental Services
Utilize
outreach
strategies and
engage
cultural
brokers?
CLC in Practice
Do we explore
new methods
for recruitment
and
retention of
culturally
competent staff
Diversity
Councils
Safe
venues for
people
to discuss
their
communication
differences?
Provide training
on addressing
bias,
discrimination,
and racism in
systems.
Standardize
ways to
assess a
candidate’s
cross
cultural
skills
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20. DBDHS
Virginia Department of
Behavioral Health and
Developmental Services
CLC in Practice
Use varied
approaches
to communicate
With individuals
who experience
cognitive disabilities
Hire bilingual/
bicultural staff
Require the use
of qualified
interpreters
Linguistic
Competence
Pre-test the readerfriendliness of
enrollment
and education
materials
with focus groups
Offer multilingual
Tele-communication
systems
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21. DBDHS
Virginia Department of
Behavioral Health and
Developmental Services
Critical Components of a CLC Plan
You don’t know where to go if you don’t know where you are.
Engagement
Evaluate/
Document
Achievement
Assessment
Organizational
Cultural
Competence
Implement
Plan
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