Cultural competence pdf

Speaking of Disparities, did you know that?…

Racial/ethnic groups Have less access to, and availability of, mental health

services Are less likely to receive needed mental health services Often receive poorer quality mental health treatment Are underrepresented in mental health research

African Americans have higher death rates than Whites for 12 of the 15 leading causes of death

Did you also know that?… Hispanic/Latino and African American children

are less likely to receive specialty mental health care as opposed to white children

Suicide is the second leading cause of death for American Indian and Alaska Native youth in the 15-24 age group, 2.5x the national average

82% of youth charged in adult courts are youth from racial/ethnic groups

And… Hispanic/Latina and Asian American female teens

have the highest rates of depression

Children of Color are over-represented in the JJ and Child Welfare systems and for the most part under-represented in the community based mental health system

Reducing disparities for ethnic/racial groups would have saved $229.4 billion in 2003-2006

Eliminating disparities for racial/ethnic groups would have reduced indirect costs associated with illness and premature death by more than $1 trillion between 2003 and 2006

Safe Schools/Healthy Students Strategic Planning for Sustainability

Ken Martinez, Psy.D.Technical Assistance PartnershipAmerican Institutes for Research

Washington, D.C. / Corrales, New MexicoMay 18-19, 2011

The Color of Americais Changing Even More in 2011_____________ White (Non-Hispanic) 196.8 million 63.7% + 1% Latino/Hispanic 50.5 million 16.0% +43% African American 38.9 million 12.6% +12% Asian American 14.6 million 4.8% +43% American Indian/

Alaska Native 2.9 million .9% +18.4 Native Hawaiian

and other Pacific Islander .5 million .2% +35.4

Other race 19.1 million 6.2% +24.4 Bi/Multi-racial 9.0 million 2.9%__ +32.0_

People of Color >135.4 million/308.7 43%(Not counting all other ethnic groups) (US Census Bureau, 2011)

Ken Martinez, Psy.D. 5


7Ken Martinez, Psy.D.

Projected Rate of Increase of Youth of Color in US from 1995-2015

American Indian/Alaska Native +17% African American +19% Hispanic/Latino +59% Asian American, Native Hawaiian

and other Pacific Islanders +74% Caucasian/White - 3%



What is Cultural and Linguistic Competence (CLC)?

Cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or amongst professionals and enables that system, agency, or those professionals to work effectively in cross-cultural situations. (Cross, et al., 1989)

It is about “respect” and ultimately, about eliminating disparities and disproportionalities


Examples of what CLC is… Vision, mission, logic modeling,

and strategic planning that is aligned and reflects commitment & action to CLC values, practices and outcomes at all levels -

A safe organizational climate based on trust and mutual respect

Individual and organizational self-assessment which leads to individual and organizational change that addresses challenges

Sufficient resources (human and financial) to reflect the leadership’s commitment to infuse CLC into practice and sustain it over time

Ken Martinez, Psy.D.11

Examples of what CLC is… Administration, management

and staff mirroring the population(s) served proportionately – Adult role modeling/Practicing what we preach

Policies and procedures that operationalize CLC in daily work (organizational structure, planning, design, budgeting, P&P, implementation, evaluation)

Contracts with providers, agencies, community partners, etc. that include specific contractual expectations about CLC with incentives/penalties


Examples of what CLC is… Administrative and staff performance appraisals that include

CLC performance measures that are directly linked to salary increases and promotions

A receptive organizational environment that promotes addressing race, ethnicity, class, disability, privilege, power, gender, sexual orientation, historical trauma, spirituality and other psychosociocultural issues relevant to the school, community and staff

A CQI process (productive use of data) that is directed to eliminating disparities in access, availability, quality and outcomes for un-served/underserved student populations


Examples of what CLC is not…

A “color-blind” philosophy and approach An “add on” or “overlay” or “just another

(unfunded) government requirement” Limited to ethnic/racial groups Just a translated brochure Just literature with faces of children of

different colors Just serving ethnic food or playing ethnic

music in class or at trainings/gatherings


Examples of what CLC is not… Choosing a youth of color to make a

presentation because s/he is a youth of color Asking a receptionist or maintenance worker

to interpret Having a person of color on an advisory

board as the token representative of the diverse community

Assuming that a staff member of color is culturally or linguistically competent –stereotyping and unfairly placing burden on him/her

Assigning all work associated with CLC to one individual – relieving everyone else of ownership, reducing likelihood of system infusion which undermines sustainability


Examples of what CLC is not… Collecting demographics on

ethnic/racial populations and not using the data to address and eliminate disparities – cost and burden vs. value

Stereotyping individuals because they belong to an ethnic/racial group, lower SES group or underserved population (LGBTQI2-S), based upon our limited and sometimes incorrect knowledge of that group

Ignoring “youth culture” “Western benevolence” – we know what

is best for you! (cultural deprivation/ disadvantaged model)


Besides Doing the “Right Thing”

What is the Ultimate Goal of Cultural and Linguistic

Competence?….

Eliminating/Reducing Disparities Eliminating/Reducing

Disproportionalities Improving access, availability,

quality/appropriateness, accountability, affordability, utilization and outcomes


Disproportionality refers to a situation in which a particular racial/ethnic group of children is represented in child welfare, juvenile justice, mental health or other child serving systems at a higher percentage than other racial/ethnic groups and the general population. Over/Under-representation - the difference between how

children/ youth are represented

Disparity refers to disparate or inequitable treatment (how the individual is treated) or services (types, access, availability, utilization, affordability, quality, appropriateness, quantity) provided to children/youth from ethnic/racial groups and their outcomes as compared to those provided to similarly situated White children/youth.

Adapted from Race Matters Consortium, 2001

Definitions

Institutional○ Laws, policies and practices○ Structural/Institutional racism

Social Determinants○ Socio-economics, education, employment, housing,

transportation○ Geography / physical environments○ Biology○ Access to/availability/affordability/utilization/quality of services ○ Individual discrimination/prejudice by race, gender, or class ○ Social or environmental stressors / support○ Court/agency culture

Cultural Differences○ World view○ Historical trauma - issues of trust○ Health/wellness/illness/curative beliefs○ Language, values, beliefs, traditions, practices and rituals

Causes of Disparities

Disparities and Disproportionalities of Children of Color “Do your homework” - learn about what

D & D exists in your schools/communities Over-representation in juvenile justice/

child welfare/special education Under-representation in prevention

activities, mentoring programs and community based services/supports

Develop strategies to reduce/ eliminate/increase accordingly

That is all great, but HOW do we do this?Ken Martinez, Psy.D. 20

Data, Data, Data…Did I say Data?

If you don’t identify it, it won’t get counted

If you don’t count it, it won’t get measured

If you don’t measure it, it won’t be in the budget

If it isn’t in the budget, nothing will happen!Ken Martinez, Psy.D. 21

Steps to Gathering and Using Data Get baseline data – collect only what you need

Value vs. Burden Use available Federal, state, county, local, agency sources Begin with census data and projections, American

Community Survey http://www.census.gov/acs/www/

General data points to review Ethnicity, race, income, language preferences/ spoken,

length of residency, acculturation, generation in US Agency data to review

Ethnic/racial percentage/proportion at various points in the systems (child welfare, juvenile justice, special education, other)

“Mine the data” – Dig deeper


http://www.census.gov/acs/www/�

Systems Data from Juvenile Justice -Proportionately by Race/Ethnicity Type of alleged offense Time of alleged offense Location of alleged offense Rates of arrest Rates of, and lengths of stay in, detention/long-

term placement Type of prosecutorial and judicial decisions at

disposition Diversion rates Alternative service rates Availability/quality of services/supports in lock-up


Systems Data from Mental Health -Proportionately by Race/Ethnicity Rates of inpatient/residential care Rates of outpatient/community based

care Rates of preventive activities/programs Rates of access, availability, utilization,

affordability, appropriateness, quality and outcomes of services/supports


Systems Data from Schools –Proportionately by Race/Ethnicity Rates of expulsions Rates and lengths of in/out of school detention Rates and lengths of suspensions Reasons for expulsions/suspensions/detentions Rates of special education placements by type Rates of gifted program placements Rates of IEPs Rates of referrals for mental health/substance

abuse services/supports Rates of referrals to police/juvenile authorities



Steps to Gathering and Using Data Develop community needs

assessment to specifically identify individual/community needs through an inclusive participatory action research process

Attempt to Set up data systems uniformly across

agencies Collect data uniformly for comparison

purposes Set up data systems to be able to

disaggregate/stratify data Mine the data (again)


Community Example A case of disproportionalities – Special Ed and JJ Used data to track every referral – to deal with the

elephant(s) in the room Analyzed demographics Student Climate Survey and clinical data

Outcomes Parent Advisory Board Parent University Student Advisory Committee Staff development/training Study sessions Family involvement is crucial Engagement of all partners “authentically” Mined the data – dug deeper, disaggregated/stratified data Continuous quality improvement processes


What does this have to do with me?

Engage all partners authentically It is all about the community and what it needs If you don’t ask the hard questions (confront the

elephant), no significant change will happen Data driven planning and implementation

promotes sustainability Don’t be satisfied with just what you see, dig

deeper Focusing on one or more of the disparities or

disproportionalities can make a significant contribution to community


How do we become good stewards in our communities and focus on sustainability?

Leadership with vision Political will Commitment and resolve Shared ownership Dedicated resources Meaningful and authentic

partnership and collaboration with community


How do we become good stewards in our communities and focus on sustainability?

Collecting and using data smartly and strategically – dig deeper again

CQI process directed at eliminating disparities and addressing domains

Accountability to our community

Training/technical assistance


Safe Schools/Healthy Students What have you done to promote and

infuse CLC by eliminating/ reducing disparities/ disproportionalities in your communities?

Are you using data wisely (addressing the elephants in your room)?

What are your outcomes?

What are your challenges?

How have you met those challenges?

What do you need to succeed and sustain?


Muchas Gracias


References

Cross, T., Bazron, B., Dennis, K., and Isaacs, M. Toward a Culturally Competent System of Care, Volume 1. Washington, D.C.: Georgetown University. (1989.)

U.S. Census Bureau http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf


http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf�

http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf�

Health & Medicine

Cultural competence pdf