Cultural Competency for Anti-Drug Coalitions

Implementing Evidence-Based Practices for Culturally Diverse Communities2014 Annual ConferenceAugust 7, 2014Orlando, FL

1Michael D. Dozier, Principal & FounderCarrington, Holland & Leigh, Nonprofit Consulting Services (601) 316-7334 Mobile, Office 601-427-5828dozier_michael@yahoo.comwww.chlnonprofit.com 2Section 1. CORE CONCEPTS3CultureThe shared values, traditions, norms, customs, arts, history, folklore, and institutions of a group of people that are unified by race, ethnicity, language, nationality, or religion

Source: Perspectives of Difference, Division of General Internal Medicine, University of California, San Francisco4Culture of Origin Ones culture of origin provides him/her with a basic understanding of the world. It provides the means to perceive and explain our experiences. It teaches about customs, philosophy, and behavior.5Culture - an individual can identify with multiple groupsNational originEthnicityRaceGenderSexual orientationReligionRural, urban, suburbanSocio-economic status6Competence Acquisition of knowledge, skills, and experience necessary for the development and implementation of services to different groups served7U.S. Dept. of Health and Human ServicesA set of behaviors, attitudes and policies that come together in a system, agency, or program or among individuals, enabling them to function effectively in diverse cultural interactions and similarities within, among, and between groups.8Cultural Competence is a point on a continuum that represents the POLICIES and PRACTICES of an organization, or the VALUES and BEHAVIOR of an individual which enable that organization or person to interact effectively in a culturally diverse environment.9ProficiencyCompetencePre-CompetenceIncapacityDestructivenessBlindnessCultural Competence Continuum10Four levels to the concept1. Cultural knowledge Individuals know about some cultural characteristics, history, values, beliefs, and behaviors2. Cultural Awareness next stage, individual is open to the idea of changing cultural attitudes11Four levels to the concepts3. Cultural Sensitivity knowing differences exist between cultures, but not assigning values to the difference. At this point clashes, and internal conflicts most often occur.12Four levels of the conceptCultural Competence, brings together the previous stages, and adds operational effectiveness. A culturally competent organization brings together different behaviors, attitudes, and policies and works effectively in cross-cultural settings to produce better results

Source: Community Tool Box, Univ. of Kansas13Cultural Competence is not the same as cultural diversity. Cultural Diversity DIFFERENCES in race, ethnicity, language, nationality, or religion among various groups within a community. A community is said to be culturally diverse its its residents include members of different groups.14Guiding Principles of Cultural Competency Each group has unique cultural needs

Action: Make room in your organization for several paths that lead to the same goal15Guiding Principles of Cultural Competency Diversity within cultures is important

Action: Recognize that cultural groups are complex and diverse, do not view them as monolithic16Guiding Principles of Cultural Competency People have group identities and personal identities

Action: Although it is important to treat all people as individuals, also acknowledge their group identity17Guiding Principles of Cultural Competency People are served in varying degrees by the dominant culture

Action: Recognize that what works well for the dominant cultural group, may work against members of other cultural groups18Guiding Principles of Cultural Competency Culture is ever-present

Action: Acknowledge culture as a predominant force in shaping behaviors, values, and institutions.19Section 2Value and importance of cultural competence 20Cultural Competence Why is cultural competence important for you, your organization, and your community?21 Why is being culturally competence important to you?22Benefits of Organizational Cultural CompetenceIncrease respect and mutual understanding among those involvedIncreases civility in problem-solving through new perspectives, ideas, strategiesDecreases unwanted surprises that might slow progress23Benefits of Organizational Cultural CompetenceIncreases participation and involvement of other cultural groupsIncreases trust and cooperationHelps overcome fear of misteaks, competition or conflictPromotes inclusion and equity

Source: Community Tool Box, Univ. of Kansas24Thus, How could your organization benefit from being culturally competent (if it isnt already!)?25

Organizations have a culture of policies, procedures, programs, and processes, and incorporate certain values, beliefs, assumptions and customs An organizational culture may not lend itself to culture competence, so thats where skill building comes in.

Source: Univ. of Kansas, Community Took Box26

Critical Domains for Measuring Cultural Competencies

Literature suggests that cultural competence must be evidenced or manifested in a broad range of spheres or areas.

Source: HRSA - OMH

27Physical EnvironmentPolicyTrainingCommunicationStyleValuesCultural Competency DomainsCommunity ParticipationEffective Prevention28Organizational DiversityPrimaryEthnicityGenderSexual OrientationSocial ClassSpiritual beliefs and practicePhysical and mental ability29Organizational DiversityOther types less salientAgeLanguageEducationCustomsCustomsSkills and TalentsNational/regional origins30Challenges for ProfessionalValue DiversityUnderstand their cultural biasesInternalize Cultural KnowledgeDevelop Adaptations to Diversity

Source: HRSA Office of Minority Health31Indicators of culturally competent organizationsOutreach outreach to diverse groups is encouraged and is part of organizational plan

Cultural concepts inclusive language is used: cross-cultural concepts are understood32Indicators of culturally competent organizationsLeadership leadership is supportive and committed to cultural competence

Vision/Mission diversity is integral to the program vision/mission

Staff composition staff reflects the diversity of the community

33Indicators of culturally competent organizationsTraining/staff development Organization provides/facilitates training on cultural diversity issues.

Collaboration staff and diverse community members work together and share responsibility for addressing substance abuse problems34Section 3 Building a Culturally Competent Organization35Action Steps for Achieving Cultural CompetenceDevelop support for change throughout the organization (who wants change and who doesnt?) Is this a top-down mandate? How deep is the buy in? Do you need a representative committee?36Action Steps for Achieving Cultural CompetenceIdentify the cultural groups to be involved.

Who needs to be involved in the planning, implementation, and reinforcement of the change?37Action Steps for Achieving Cultural CompetenceIdentify barriers to cultural competence at work in your organization

What is currently not working, what will slow you down or stop you?38Organizations barriersLack of understandingLack of resourcesLack of leadership commitmentLack of training opportunitiesStaff resistance

39Cross-Cultural Stumbling BlocksLanguage different languages, dialects, certain concepts hard to translateClass-related valuesCulture-related values different meanings and values attached to behavior, events, situationsNon-verbal communication gestures, facial expressions, eye contact may have different meanings40Cross-cultural Stumbling BlocksStereotyping assignment of characteristics or beliefs about another culture based on prejudice, or limited exposureRacismEthnocentricity belief that ones ethnicity provides the true or correct view of the world41Action steps for Achieving Cultural Competence4. Assess your current level of cultural competence

What knowledge, skills, and resources can you build on? Where are the gaps?42Some guideposts for assessing organizational cultural competenceExperience or track record of involvement with the target populationStaffingTraining availability and scopeCommunity representationLanguage43Further guideposts for assessing organizational cultural competenceEnvironmentMaterialsEvaluationOn-going self-assessment44Action Steps for Building Cultural CompetenceIdentify the resources needed

How much funding is required to bring about the changes? Where can you find the resources?45Action Steps for Building Cultural Competence6 Develop goals and implementation steps and deadlines for achieving them.

46Action Steps for Achieving Cultural Competence7. Commit to an ongoing evaluation of progress (measuring outcomes) and be willing to respond to change

What will success look like? How do you know you are on the right track?47Interventions for increasing organizational cultural competenceIncrease the number of diverse persons in the organizationDevelop educational plan for employees, coalition members, volunteers, to improve competencies required for effective cross-cultural work

48Interventions for increasing organizational cultural competenceIdentify and re-write policies, practices, and structures that limit the full participation of diverse communitiesHold educational events exploring diverse groups history, cultural, issues, and strengths49Interventions for increasing cultural competenceAssure that the right voices are at the table

Establish, communicate, and model how the mission, vision, goals and values of the coalition align with and are served by a diverse membership and inclusive practices.50Section 4 Building Cultural Competency in your Community Coalition51Why is understanding culture important to build community?Need large number of people to join forces.

Each group has unique strengths and perspectives we can all benefit from.

Understanding culture will help us overcome and prevent racial and ethnic divisions.52Why is understanding culture important to build community?People from different cultures have to be included in the decision-making process.

Appreciation of culture goes hand-in-hand with a just and equitable society.

Should understand the contributions of all to our common history53Coalition cultural competence community assessment Assessment Activities:

Does your community assessment include information about the major cultural groups in your community?

Have members of diverse groups assisted the organization in analyzing and interpreting the data?

54Cultural AssessmentsValues and lifewaysReligious, philosohical, and spiritual belfeifsEconomic FactorsEducational FactorsTechnological FactorsKinships and social tiesPolitical and Legal FactorsSource: Leninger Conceptualization of transcultural Health Care Systems, 199355Cultural AssessmentsValues and lifewaysReligious, philosohical, and spiritual belfeifsEconomic FactorsEducational FactorsTechnological FactorsKinships and social tiesPolitical and Legal FactorsSource: Leninger Conceptualization of transcultural Health Care Systems, 199356 Cultural competence community assessment Planning:

Does your strategic plan address needs of diverse groups in your community? Do your organizational plans incorporate cultural competence concepts?57Organizational cultural competence community assessment Community mobilization:

Does your organization engage all sectors of your community in a community-wide prevention effort? Are some groups not adequately represented or at the table?58Program SelectionWho conducted the research, developed the program?How did the researchers/program developers control for cultural competency in the program design?What groups were included in the studies? 59Program SelectionHave any replications been done in diverse communities?Are materials available in languages other than English? Who did the translation? Were they tested?Is the program developer willing to work with others to adapt the program?

60Organizational cultural competence assessment Implementation:

Have you selected a prevention program that needs to be adapted to meet the needs of diverse groups?61Fidelity and AdaptationIdentify the theory base behind the programEmploy core components analytic dataAssess fidelity/adaptation concerns for the particular implementation siteConsult with model program developer

62Fidelity and AdapatationConsult with organization and/or community in which the implementation will take placeConduct focus groupsIdentify other adaptationsIdentify translations, is possibleIdentify local experts for assistance, your state SSA, national organizations63Fidelity and Adaptation Develop an overall implementation plan based on these inputs64Evaluation GuidelinesDefine the population preciselyDevelop collaborations with the target populationEncourage buy-inProvide timely feedback and results in clear, useful formats conveyed through culturally appropriate methods65Evaluation GuidelinesConsider acculturation and biculturalism in interpretation and utilization of dataKnow when to aggregate the within-group data from a heterogeneous sample and still maximize external validityAvoid deficit model interpretations66Best Practices for Culturally Competent EvaluationDevelop specific cultural knowledgeExplicitly examine the theoretical framework that is the foundation of your researchDefine and measure ethnicity in a meaningful manner

67Best PracticesMake sure your analyses reflect study question and that you have sufficient power to get accurate answers

Interpret results to reflect the lives of the people studied.

Source: Guidelines and Best Practices for Culturally Competence Evaluations, The Colorado Trust, 2002.68Section 5 Culturally Proficient Behavior69Culturally proficient behaviorValue Diversity (name the differences)

Celebrate and encourage the presence of a variety of people in ALL activities

Assess your culture/claim your identity70Culturally Proficient BehaviorRecognize how your culture affects others

Understand how the culture of your organization affects those whose culture is different71Culturally proficient behaviorHave in place effective strategies for resolving conflict among people whose cultural backgrounds and values may be different from your.

Understand the effect that historic distrust has on present day interactions72Culturally proficient behaviorHave a training/staff development program that provides information and skills that enable all to interact effectively in a variety of cross-cultural situations and incorporates cultural knowledge.73Section 6 Resources74Cultural Competence ResourcesCaldwell, C., Jackson, J., Tucker B., & Bowman, P. Culturally-Competent Research Methods in Advances in African American Psychology, 1999.

Catalano R., Morrison D., Wells E., Gillmore M., Iritani B., and Hawkins D., Ethnic Differences in Family Factors Related to Early Drug Initiation Journal of Studies on Alcohol, Vol. 53, No. 3, 1992.

Burchum, J., Cultural Competence: An Evolutionary Perspective Nursing Forum, Vol. 37, No. 4, 2002.75Cultural Competence ResourcesGeron, S. Cultural Competency: How is it Measured? Does it make a Difference? Generations, Fall 2002.

Luquis R., and Perez, M. Achieving Cultural Competence: The Challenges for Health Educators American Journal of Health Education, May/June 2003.

Resnicow, K., Soler, R., and Braithwaite R. Cultural Sensitivity in Substance Abuse Prevention Journal of Community Psychology, Vol. 28, No. 3, 2000.

Roosa, M., Dumka, L., Gonzalez, N., and Knight, G. Cultural/Ethnic Issues and the Prevention Scientist in the 21st Century APA, Prevention and Treatment, Vol. 5, Art 5, 2002. 76Cultural Competence ResourcesTerrell, D. Ethnocultural Factors and Substance Abuse: Toward Culturally Sensitive Treatment Models Psychology of Addictive Behaviors, Sept. 1993, Vol. 7, No. University of Kansas, Community Tool Box, Tools, Chap. 27. Cultural Competence in a Multicultural World. http://ctb/ku/edu/tools/en/chapter_1027.htm

Zickler, P.Ethnic Identification and Cultural Ties May Help Prevent Drug Use NIDA Notes, Research Findings, Vol 14, No. 3, Sept. 1999.77Cultural Competency ResourcesU.S. Dept. of Health and Human Services, Health Resources and Services Administration, Office of Minority Health, Conceptualizing Cultural Competence and Identifying Critical Domains http://www.hrsa.gov/OMH/cultural/sectionii.htm

U.S. Dept. of Health and Human Services, Office of Minority Health, National Standards for Culturally and Linguistically Appropriate Services in Health Care. Washington, D.C. 2001

U.S. Dept. of Health and Human Services, Office of the Surgeon General, Mental Health: Culture, Race and Ethnicity. Rockville, 200178