Fundamentals of Cultural and Linguistic Competence in Recovery-Oriented Systems of Care OFFICE OF BEHAVIORAL HEALTH Disclaimer The content of this training should not be relied upon for diagnosis or treatment of a mental health condition. Resources listed in this document do not constitute an endorsement, nor are these resources exhaustive. Nothing is implied by inclusion or when a resource is not referenced. Objectives 1. Review definitions of cultural and linguistic (use of language)
competence 2. Understand the importance of cultural diversity and the use of language in the course of all their interactions with consumers and their families 3. Understand how the lack of cultural and linguistic competence has led to negative outcomes for people 4. Discuss and understand how ones own culture and their own self awareness with respect to others will impact their interactions with consumers and their families What do we mean by diversity The ISMS Gender (sexism) Race (racism)
Disability Age (ageism) Ethnicity Socioeconomic (classism) LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS Religion Sexual Orientation 4
We are a Diverse Nation 5 We Are A Diverse Nation Current Total US population-308,745, 538 (according to the 2010 census) African-Americans - 13.6% of the US population National Hawaiians/Other Pacific Islanders - 0.2% of the US population American Indians/Alaska Natives 0.9% of the US population Asian Americans/Pacific Islanders - 5% of the US population Latinos/Hispanics 16.3% of the US population
(US Census,2010) LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS 6 We are a Diverse Nation The following states report more than 45% of the population who speak a language other than English at home, spoke English less than Very Well. Arkansas, Oklahoma, Tennessee, Alabama, Georgia, South Carolina, North Carolina, Florida, New York, Illinois, Nevada, California, Oregon (US Census 2010) LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
7 Louisiana is a Diverse State Based on 2010 language use information published by the US Census Bureau, In Louisiana 328,041 people or 8.2% of the population speak a language other than English at home. 31.8%, reported their English as something below very well. (US Census, Economics and Statistics, 2010) LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS 8 These data is essential and
may account for the following: Linguistic barriers exist for people who are not proficient in English Linguistic barriers resulting in lack of access to care, less than adequate care, poor treatment adherence, increased problematic incidents, and increased costs LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS 9 What is Cultural and Linguistic Competence
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS 10 Cultural and Linguistic Competence A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or amongst professionals and allows that system, agency, or those professionals to work effectively in cross-cultural situations. LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS 11 Cultural and Linguistic Competence
The word culture is used because it implies the integrated pattern of human behavior that includes thought, communication, actions, customs, beliefs, values, and institutions of a racial, ethnic, religious, or social group. The word competence is used because it implies having the capacity to function effectively. LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS 12 Cultural and Linguistic Competence A culturally competent system of care acknowledges and incorporates-at all levels The importance of culture The assessment of cross-cultural relations
Vigilance towards the dynamics that result from cultural differences The expansion of cultural knowledge, and The adaptation of services to meet culturallyunique needs. LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS 13 Cultural and Linguistic Competence impacts every aspect of work Structure Practice Cultural Competence Policy
Attitude (Focal Point, 1988) LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS 14 Culture - What is it? It is everything we have learned: the meaning of things the values we have the information we received as to what is normal behavior Culture is transmitted to us by our family, community, and society
Culture influences and impacts feelings, thinking, and doing. It has a strong relationship to worldviews LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS 15 Expressions of Culture
Language Food Family Use of space/land Music Dance Religion Dress LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS 16 Why is this Important Facilitates effective and efficient communication Respects diversity
Avoidance of misinterpretation Creates consensus Uses common sense and logic LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS 17 Placing Cultural and Linguistic Competence into Practice: Dissecting The Concept of Worldview A worldview refers to how people see the world. It is the invisible lens through which all of us view the world. It is intimately related to a persons cultural and linguistic contexts.
It is our philosophical view of life, and affects how we think, make decisions, our values, priorities, and choices. (Focal Point, 1988) LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS 18 The multidimensional and multifaceted aspect of worldview. educational experience travel experience culture occupational/career
group membership mental/phys/disability nationality economic status sex regional background political af filiation gender identity and expression mental/phys/abilities
important belief s important values religious tradition f amily backgroud age race ethnic heritage sexual orientation marital status LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
19 Factors in the external environment which impact cultural and linguistic competence Institutional (including disparities) Racism, prejudice and discrimination Political socio-economic factors Support network -historical Workforce diversity and values Demographics
(New Freedom Report, 2003) LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS 20 Important Definitions Linguistics-Refers to human language and speech. LEP-Limited English Proficient; a person who is LEP is defined by the Census as someone who speaks English less than very well. These individuals often cannot speak, read, or write the English language at a level that permits them to interact effectively with healthcare providers. (Sampson, 2006) LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
21 Important Definitions Bilingual: A term describing a person who has some degree of proficiency in two languages. A high level of bilingualism is the most basic of the qualifications of a competent interpreter or translator, but by itself does not insure the ability to interpret or translate. (Sampson, 2006) CLAS: National Standards for Culturally and Linguistically Appropriate Services in Health Care LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS 22 LANGUAGE IDENTIFICATION
CARDS OR POSTERS: A language card identifies the language spoken by an individual (I speak__language), and is often in both English and the persons spoken language. The card can inform the health care provider of the language needs of the individual. These are commonly referred to as I Speak cards or posters (Sampson, 2006) 23 El telfono Los documentos Telephone
Documents Examples of I Speak Cards Spanish Translation Las llaves La tarjeta del cajero Keys automtico ATM Card LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
24 INTERPRETING The process of understanding and analyzing a spoken or signed message and re-expressing that message faithfully, accurately, and objectively in another language, taking the cultural and social contexts into account. The purpose of interpreting is to enable communication between two or more individuals who do not speak each others language. INTERPRETING-refers to the process (Sampson, 2006) LOUISNA DEPARTMENT OF HEALTH AND HOSPITALS 25
INTERPRETER A person who renders a message spoken in one language into a second language. Within the language professions, interpreting is distinguished from translating according to whether the message is produced orally (or manually) or in writing. In popular usage, however, the terms translator and translation are frequently used for conversion of either oral or written communications INTERPRETER-refers to the person (Sampson, 2006) LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS 26
What is a Culturally Competent Professional Five essential elements define culturally competent professionals: 1. An awareness and acceptance of differences 2. An awareness of ones own cultural values 3. An understanding of the dynamics of difference in the helping process 4. Basic knowledge of the clients culture 5. An ability to practice skills to fit the clients cultural context (Focal Point, 1988) LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS 27
Becoming Culturally Competent Am I aware of my own cultural values and how my culture drives the decisions I make? Am I aware that differences exist and can I adapt to those differences? What are the dynamics of difference and what happens when people from different backgrounds meet? Do I make efforts to increase my knowledge base? Am I able to adapt my skills to fit the events cultural context? LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS 28 Why is Cultural and Linguistic
Competency Important? 1. Unequal access and treatment of minorities Healthcare disparities exist across the following: Diagnostic labels Access to services Treatment choices
The range and type of settings where treatment is obtained LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS 29 Why is Cultural and Linguistic Competency Important? 2. A number of striking disparities exist in mental health services among minorities Less likely to have access to available mental health services Are less likely to receive needed mental health services Often receive poorer quality care Are significantly under-represented in mental
health research New Freedom Report, 2003 LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS 30 Why is Cultural and Linguistic Competence Important? 3. Helps us to understand how people express Their pain What they label as symptoms How they communicate about their symptoms Their beliefs about the causes and/or resolutions of their symptoms, their feelings about helpers, and What they expect treatment to accomplish (McGoldrick et al., 2005) LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
31 Why is Cultural and Linguistic Competence Important? 4. To help us understand Trauma histories Prevalence of co-occurring disorders Stigma, poverty, discrimination and injustice
Myths and stereotyping Reduction of seclusion & restraint Immigration issues Ways in which we need to both develop and modify our best and promising practices. LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS 32 Key Skills in Being a Cultural and Linguistic Helper LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS 33
Obtaining Knowledge It is impossible to learn every possible culture but it is important to want to communicate and understand the consumers culture and linguistic context Be aware of your own cultural and linguistic background When indicated, learn how to use interpreters, obtain translated documents, and I speak cards Understand how stigma, discrimination, and poverty impact people Be aware of your own values and biases, and how they may effect your interactions with consumers Be aware of possible resources among ethnic minorities (Saldana, 2001) LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS 34
Verbal non-verbal be aware of personal space Volume intensity Differences in conversation flow interruptions and taking turns Use of touch
Ask Questions Think more Than once Distinguish Perspectives Strategies For Effective CrossCultural Communication Be Flexible Assessment and use of facial expression
Be Honest Build Self-awareness Variation in eye contact and feedback Recognize the Complexity Avoid Stereotyping
Listen Actively Respect Differences Silences The meaning and use of gestures (Saldana, 2001; Focal Point, 1988) 35 35 Personal Characteristics Communication and genuineness are key
Helpers need to express empathy (where appropriate), warmth, flexibility, and encourage a problem-solving approach Helpers should view and accept diversity as a strength of our nation and communities Helpers should communicate a willingness to work with people who are different (Saldana, 2001; Focal Point, 1988) LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS 36 Personal Characteristics of Competent Staff Ownership, recognition, and articulation of personal feelings towards people who are different Recognition of stereotyping, personal biases, and
sense of privilege, all of which may negatively impact your capacity to help The ability to apologize when indicated, and to create a warm and inviting environment Greeting a person every day with a smile can go a long way! (Saldana, 2001; Focal Point, 1988) LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS 37 One Size Does Not Fit All !!! LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
38 The NASMHPD 2009 Workforce Development curriculum posted on this LMS website, including the text, illustrations, designs, icons, video clips, documents, and all other content ("Material"), is intended for the use of the State of Louisiana only. The State of Louisiana has obtained permission to use the NASMHPD 2009 Workforce Development Curriculum within its contracted LMS (Essential Learning). None of the Material may be copied, reproduced, distributed, republished, downloaded, displayed, posted or transmitted in any form or by any means ("Use" or "Used") outside of the State of Louisiana. All requests for the curriculum should be forwarded to Robert W. Glover, Executive Director, NASMHPD - [email protected]
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