Cultural and Linguistic Competence Policy in Action VCU MSW Lecture Feb 2014

DBHDSVirginia Department of

Behavioral Health andDevelopmental Services

“Policy in Action” Planning for Culturally and Linguistically Appropriate

Services in Human Services

Cecily RodriguezOffice of Cultural & Linguistic Competence

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DBDHSVirginia 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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DBDHSVirginia Department of Behavioral Health and

Developmental Services

What is culture?

Office of Cultural and Linguistic Competency - DBHDS

A COMMON FRAMEWORK

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DBDHSVirginia Department of Behavioral Health and

Developmental Services

CULTURE IS FLUID

and IT CAN BE….

Thick

Thin

Compartmentalized

Dr. Viviann Jackson, NCCC

Office of Cultural and Linguistic Competency - DBHDS

Rethinking Culture

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DBDHSVirginia Department of Behavioral Health and

Developmental Services Dimensions of Culture

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DBDHSVirginia Department of Behavioral Health and

Developmental ServicesIs Culture an Iceberg?

Culture is Not an Iceberg – Milton J. Bennett PhD. 2013

RACE

CULTURAL ARTIFACTS

(CLOTHING, HAIRSTYLE, ETC)

LANGUAGE

AGE

ATTITUDE TOWARDS ANIMALS

DEFINITION OF SIN

GOVERNING CHILD-RAISING

CONCEPTS OF HUMOR

VISIBLE

HIDDEN

Don’t forget to adjust for acculturation, generational differences and other variables

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DBDHSVirginia Department of Behavioral Health and

Developmental Services

Office of Cultural and Linguistic Competency - DBHDS

ROCCO RODRIGUEZ

and the Iceberg Effect

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DBDHSVirginia Department of Behavioral Health and

Developmental Services

What is Cultural CompetenceNational Center for Cultural Competence

Value

Diversity

Conduct Self

Assessment

Manage the

Dynamics of

difference

Acquire and institutionaliz

e cultural knowledge

Adapt to the cultural contexts of

your community

And incorporate the above in all aspects of policy making, administration, practice, service delivery and involve systematically

consumers, key stakeholders and communities.

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DBDHSVirginia 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 SystemsPolicies and procedures in place and an infrastructure

that supports diverse communities

System’s LevelsLaws and regulations in place and an infrastructure that supports diverse

communities

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DBDHSVirginia Department of Behavioral Health and

Developmental ServicesWhat is Linguistic Competence?

National Center for Cultural 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.

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DBDHSVirginia Department of Behavioral Health and

Developmental Services The Case for CLC

Disparities in Access and OutcomesMental 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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DBDHSVirginia 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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DBDHSVirginia Department of Behavioral Health and

Developmental Services The Case for CLCFEDERAL LAW

Civil Rights Act of 1964The 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 13166http://www.lep.gov/13166/eo13166.html

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DBDHSVirginia Department of Behavioral Health and

Developmental Services

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. Number or Proportion of LEP Individuals

2. Frequency of Contact With the Program

3. Nature and Importance of the Program

4. Resources Available

The Case for CLC

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DBDHSVirginia Department of Behavioral Health and

Developmental Services The Case for CLCInova Health System Fairfax – $145,000

settlement for failure to provide sign-language 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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DBDHSVirginia 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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DBDHSVirginia Department of Behavioral Health and

Developmental Services

Models for Culturally and Linguistically Appropriate Services

Patient centeredness, cultural competence and healthcare quality – Saha, Beach, & Cooper, 2010.

Age

ncy

for

Hea

lthca

re R

esea

rch

and

Qua

lity

(AH

RQ

) 

Com

mis

sion

on

Acc

redi

tatio

n of

R

ehab

ilita

tion

Fac

ilitie

sStandards for Culturally & Linguistically Appropriate Services 2013

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DBDHSVirginia Department of Behavioral Health and

Developmental Services Organizational Planning

Technical Assistance Partnership www.tapartnership.org/docs/clcPlanTemplateFinal.doc

1. Governance and organizational infrastructure

2. Services and Supports3. Planning and continuous quality improvement4. Collaboration5. Communication6. Workforce Development

Any plan should address the six critical domains

related to cultural and

linguistic competence.

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DBDHSVirginia Department of Behavioral Health and

Developmental ServicesCLC in Practice

Utilize outreach

strategies and engage cultural

brokers?

Do we explore new methods

for recruitment and retention of culturally

competent staff

Diversity Councils

Safevenues 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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DBDHSVirginia Department of Behavioral Health and

Developmental ServicesCLC in Practice

LinguisticCompetence

Hire bilingual/bicultural staff

Use varied approaches

to communicate With individuals who experience

cognitive disabilities

Require the use of qualified interpreters Pre-test the reader-

friendliness of enrollment

and education materials

with focus groups

Offer multilingual Tele-communication

systems

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DBDHSVirginia 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.

Organizational Cultural Competence

Engagement

Assessment

PlanImplement

Evaluate/ Document

Achievement