Enhancing Culturally and Linguistically Appropriate Services in Public Health Preparedness Ira SenGupta Cross Cultural Health Care Program Seattle, WA

Enhancing Culturally and Linguistically Appropriate Services in Public Health Preparedness

Ira SenGupta

Cross Cultural Health Care Program

Seattle, WA

[email protected]

A CLAS Act

© Cross Cultural Health Care Program

Inspiration

“If you want to move people,

it has to be toward a vision

that’s positive for them, that

taps important values, that

gets them something they

desire, and it has to be

presented in a compelling

way that they feel inspired

to follow.”

— Martin Luther King Jr.


Session Goals

Identify the key concepts of the 14 Culturally and Linguistically Appropriate Services (CLAS) standards

Define the concepts of diversity, culture, and cultural competency and their relevance in public health preparedness

Describe practical applications of culturally competent communication strategies in public health preparedness


Culturally and Linguistically Appropriate Services (CLAS) Standards

14 National Recommended Standards: To inform, guide, and facilitate implementation of CLAS

Three themes:

1. Culturally competent care (Standards 1-3)

2. Language access services (Standards 4-7)

3. Organizational supports for cultural competence (Standards 8-14)


CLAS Goals

To contribute to the elimination of racial and ethnic health disparities

To improve the health of all Americans


Cultural Competency

“To be culturally competent doesn’t mean you

are an authority in the values and beliefs of

every culture. What it means is that you hold a

deep respect for cultural differences and are

eager to learn, and willing to accept, that there

are many ways of viewing the world.”

— Okokon O. Udo, PhDIntegrative Health and Wellness

Northwestern Health Sciences University


The Compelling Reasons for Cultural Competence

1. Responding to demographic changes

2. Eliminating disparities in the health status of people of diverse racial, ethnic, & cultural backgrounds

3. Understanding the impact of individual and organizational culture

4. Improving the quality of services & outcomes

5. Enhancing the workplace environment

6. Meeting legislative, regulatory, & accreditation mandates

Adapted from: National Center for Cultural Competence, Georgetown University


US’s Changing Demographics

Demographics beyond black and white—now a complex mosaic of races & ethnicities.

- 35 million Hispanics - 34.5 million Blacks - 10.5 million Asian Americans- 4 million Native Americans Most significant trend is the record growth of Hispanic Americans.

Persons with physical and mental impairments are the largest single “minority” (approx. 49 million).


US Demographics:Language & Adult Literacy Skills

According to Census 2000:Among the 262.4 million people aged 5 and over, 47.0 million (18%) speak a language other than English at home.

21% to 23% or some 40 to 44 million of the 191 million adults in the U.S. have extremely limited reading and quantitative skills (Level 1).

Source: US Census Bureau Census 2000

National Center for Educational Statistics


Question

What proportion of the 40–44 million people who speak a language other than English at home were born outside of the US?

A. 1%

B. 10%

C. 20%

D. 30%


Many Factors Contribute to Health Disparities

• Behavioral choices

• Genetic predisposition

• Nutrition

• Access to medical care

• Environmental and occupational conditions

• Poverty Source: Final Report of the Health Disparities

May 9, 2001 Washington State Board of Health


Inequality

“Of all the forms of inequality, injustice in

health is the most shocking and the most

inhuman.” — Dr. Martin Luther King Jr.


From Cultural Bump to Cultural Congruence

Defining culture, diversity, and understanding the impact on human interactions


Diversity Encompasses Issues Related to….

• race

• color

• class

• age

• experience

• ability

• gender

• ethnicity

• language

• religion

• politics

• sexual orientation

• gender identity

• socio-economic status

• resident status

...within each community


“Actually, the most important

part of culture ... is that which

is hidden and internal but

which governs the behavior

encounter.”* *Source: Edward T. Hall, 1976

Understanding Culture


Cultural Competence Actualized

The state of being capable of functioning effectively in the context of cultural differences*

*Adapted from Terry Cross, PhDNorthwest Indian Child

Welfare Association


Elements of Cultural Competence

• Awareness of one’s own culture

• Awareness and acceptance of difference

• Understanding the dynamics of difference

• Development of cultural knowledge

• Celebration of diversity


The Impact of Personal Culture on Communication

• Incorrect assumptions about the other

• Language and communication style issues

• Biases against the unfamiliar

• Personal values in conflict

• Expectations that others will conform to established norms

Adapted from Selma Myers

Conflict and Culture


Experience

“We are either equipped by our past

experiences or handicapped by them.”

— Ehab Hanna, M.D.

Department of Head and Neck Surgery

M.D. Anderson Cancer Center


Working in Communities

To offer culturally appropriate care requires being open to the expec-tations, perceptions, and realities of the various communities.


Survey Findings: Barriers to Services

• Cultural issues

• Perceived limitations of western approach to healthcare

• Money

• Bias

• Language

• Interpreters

• Transportation

• Child care


Categories of Flu Treatments—Ingested Herbal Treatments

Hundreds are used in this country.

Modern forms are often processed and lack traditional treatment information and context.

Many teas are popular and most are mildly effective at treating symptoms.

Source: Margie Akin PhD


Foods to Fight the Flu

African groundnut (peanut) chicken soup

Other traditional soups have other nutrients that may be lacking in everyday diet—such as extra protein in this traditional African chicken soup.

Source: Margie Akin PhD


Cultural Bump...

As a result of a personal interaction you are:

• confused

• frustrated

• angry

• misunderstood

• helpless

• hopeless


Ethnocentrism

Misinterpretation and misjudgment based

on looking at another person’s behavior

from your own cultural reference point.

Ethnocentric misjudgments result in

culturally biased interactions.


Power

Involves the capacity to influence, for one’s own benefit, the forces that affect one’s life. Powerlessness thus is the inability to exert such influence.

Basch (1975, p. 513) has stated that “the feelingof controlling one’s destiny to some reasonable extent is the essential psychological component of all aspects of life.”

This means that a sense of power is critical to one’s mental health. Everyone needs it.

Elaine Pinderhughes Understanding Race, Ethnicity, and Power.


The Negative Cycle of Communication

Person A Emotions

• Angry

• Hopeless

• Helpless

• Frustrated

• Confused

• Misunderstood

• Depressed

Person BActions

• Violence

• Withdrawal

• Passive-aggressive

• Blame

• Substance Abuse

• Homicide

• Suicide

©Ira SenGupta, 2002


Question

What does it take to bring you out of this negative communication cycle?

(We are opening the phone lines for group discussion. Please tell us your answer either verbally or via text chat.)


Five Steps to Cultural Competency

• Awareness of self and the other

• Acknowledgement

• Honest validation

• Negotiation

• Action: choices and options

©Ira SenGupta, May, 2002, Health and Healing


Communication Across Cultures:Skills That Make a Difference

Realize your viewpoint may not be the only one.

• Strive to be non-judgmental.

• Question your assumptions constantly.

Understand what others feel.

• Be more flexible ... less resistant.

• Celebrate & honor differences.


Key Learning

The more accurate information we have about others, the more likely we will be able to respond with respect and understanding.

The more familiar we are, the more comfortable we become. And with comfort and time, comes trust resulting in effective communications.

Familiarity Comfort Trust Effective Communications


A Summary

• Dare to bridge across barriers

• Allow for fragility due to circumstance

• Honor the mystery of building connections


Cultural Competency—A Practical View

“To be culturally competent doesn’t mean

that you will never encounter cultural

bumps. What it means is that you will be

more aware of how and why cultural

bumps happen while skillfully navigating

them for best outcomes.”

—Ira SenGupta, CCHCP, December 05


Final Thoughts...

You and IWe meet as strangers, each carrying a mysterywithin us. I cannot say who you are.I may never know you completely.But I trust that you are a person in your own right, possessed of a beauty and value that arethe Earth's richest treasures.So I make this promise to you;I will impose no identities upon you, but willinvite you to become yourselfwithout shame or fear.I will hold open a space for you in the worldand allow your right to fill it with an authenticvocation and purpose. For as long as your searchtakes, you have my loyalty.

Author Unknown


Human Rights

“Where after all do

universal Human Rights

begin? In small places and

close to home, so small

and so close that they

cannot be seen on any

map of the world.”

— Eleanor RooseveltNY Times, Dec. 1965


The Cross Cultural Health Care Program

Vision: Healthcare in every community every community in healthcare

Contact information:

Ira SenGupta, Executive Director

270 South Hanford St. Ste. 208

Seattle, WA. 98134

Ph: 206-860-0329

Email: [email protected]

Website: www.xculture.org


Further Readings

1. Quality Health Services for Hispanics: The Cultural Competency Componenthttp://www.ask.hrsa.gov/detail.cfm?id=PC00029

2. World's Apart, the video series: http://www.fanlight.com/catalog/films/912_wa.shtml

3. An excellent video: Communicating Effectively through an Interpreter http://www.xculture.org/resource/order/detail.cfm?PID=27&list=27%2C25%2C23

4. Quiz for healthcare providers on quality & culture http://erc.msh.org/quiz.cfm?action=question&qt=all


References

Quality Health Services for Hispanics: The Cultural Competency Component, 2001, p.10

U.S. Bureau of the Census, Resident Population Projections of the United States: Middle, Low, and High Series, 1996 to 2050

Boston Public Health Commission, Disparities Project Data Report, June 2006http://www.bphc.org/director/disp_data.asp

Documents

Enhancing Culturally and Linguistically Appropriate Services in Public Health Preparedness Ira SenGupta Cross Cultural Health Care Program Seattle, WA