Dimensions of Culture

1. Defining and Applying Cultural Competence for Kansas SPF-SIG Prevention Programs and Services Dimensions of Culture

2. Purpose To create an understanding of the impact of cultural competence on effective substance abuse prevention, to develop strategic approaches that address diversity in the delivery of services, and to help prevention programs implement the Office of Minority Health National Standards for Cultural Competence in Healthcare.

3. Objectives • Share tools, strategies, and structures that may be used to operationalize cultural competence in prevention services. • Address the barriers prevention programs face in efforts to become more culturally competent, responsive, and proficient. • Use national standards to assess local capacity to respond to diversity within SPF-SIG communities. • Develop a plan to address priority needs in enhance cultural competence among SPF-SIG grantees.

4. Process • Self-Guided Learning and Reflection • Virtual Workshop Modules with Resources • Coalition Assessment and Action Planning • Individual Supportive Contacts • Submission of Priority Areas for Focus and Action Plan by 5/21/10

5. The Need for Cultural Competence • To respond to current and projected demographic changes in the U.S. • To eliminate long standing disparities in the quality of prevention services to people of diverse racial, ethnic, and linguistic populations; and consideration of gender, disabilities, and sexual orientation in delivery of prevention services. • To improve the effectiveness, quality of services, and positive prevention outcomes to targeted populations.

6. SPF Cultural Competence: 3 Levels • State Level: • Establish and monitor cultural competence as it relates to the steps of the SPF • Community: • Implement policy and monitor prevention program service delivery and evaluation • Program Level: • Deliver culturally appropriate prevention programs, policies, and practices and implement culturally tailored/designed and appropriate evaluation

7. CSAP Cultural Competence Requirements for Funded States Support implementation and maintain a state and program level data base consisting of the following descriptive information: • Types of plans and strategies designed to implement culturally appropriate policies, programs & practices; • Organizational capability & experience of awardees in implementing culturally appropriate/competent prevention interventions; • Utilization, reliability & validity of culturally appropriate psychometric methods and measures; • Types and utilization of culturally appropriate adaptations with evidence based programs, policies, and practices.

8. Potential Domains for Cultural Competence • Organizational Values • Governance • Planning and Monitoring/Evaluation • Communication • Staff Development • Organizational Infrastructure • Services/Interventions (Lewin Group, et. al., 2002)

9. CSAP Definitions for Cultural Competence • A set of academic & interpersonal skills that allow individuals to increase their understanding & appreciation of cultural differences & similarities within, among & between groups. This requires a willingness & ability to draw on community-based values, traditions, & customs & to work with knowledgeable persons of & from the community in developing focused interventions, communications, & other supports. Orlandi et.al.,(1992) • …the attainment of knowledge, skills & attitudes to enable administrators & practitioners within systems of care to provide for diverse populations. This includes an understanding of that group’s or members language, beliefs, norms and values, as well as socioeconomic & political factors that may have a significant impact on their well-being, & incorporating those variables into assessment & treatment. CSAP, (1993)

10. Definitions of Terms and Concepts • Race: The biogenic traits that distinguish one group from another. Within a race of people there are many ethnic groups. • Ethnicity: A population or group's common cultural heritage, as distinguished by such characteristics as norms and customs, language patterns, values, and beliefs.

11. Definitions, Continued • Culture: The shared traditions, customs, beliefs, history, values, norms, and behaviors that provide a group with a framework for living. • Worldview: The overarching mode through which people interpret events and define reality. A racial or ethnic group's psychological orientation toward life.

12. ...and a Few More Definitions • Diversity: A range of differences in addition to race and ethnicity and includes gender, socioeconomic and educational groups, sexual orientation, physical capacity, age, and differences in spirituality and religion. • Cultural Competence: A set of congruent behaviors, attitudes and policies that come together in a system or agency or among professionals and enables them to work effectively in cross-cultural situations.

13. Definition of Terms Activity • After review and reflection on the definitions provided, what struck you? • How can these definitions help broaden your organization’s understanding of diversity and broad range of defining cultural competence?

14. Cultural Identity In what ways does: • Your self-identity impact your work in the field of prevention? • The way you believe others see you impact your work in the field?

15. Universality of Stereotypes The Institute of Medicine (IOM) found that stereotypes: • Are activated automatically, which means they are generated unconsciously • Are held even by people who believe they do not judge people based on social categories, but are unconsciously influenced by implicit biases and stereotypes in American society

16. Stereotypes, Continued • Affect how we process and recall information about others. People are more likely to remember information about others that is consistent with widely held social stereotypes • Guide expectations and perceptions and shape our personal interactions, producing “”self-fulfilling prophecies” (that is, our own beliefs about how a situation should or will unfold can actually influence the interaction so that it meets our expectations)

17. In what ways does a lack of cultural competence present consequences for effective and comprehensive prevention efforts in a community?

18. Benefits of an Organizational Assessment • Education of board, staff, and volunteers regarding the impact of cultural influence and the importance of enhancing their own personal cultural competence • Identification of the prevention program or organization's strength's in providing culturally competence services • Understanding of community perceptions of the organization's cultural competence

19. Benefits, Continued • Identification of the harmful effects of the lack of culturally competent prevention services • Justification to funders, staff, and other stakeholders of the need to initiate and commit to the process of improving the cultural competence of prevention services • Identification of the specific actions needed to begin improving the cultural competence of the organization and the prevention services and programs it provides

20. Factors to Consider in Culturally Competent Services • A thorough understanding of the historical realities of slavery, segregation, migrations, and civil rights • A contemporary understanding of the current confluence of negative forces threatening minority groups • An appreciation of and willingness to utilize the vast spiritual resources of ethnic communities

21. Factors to Consider, Continued • Appreciation for the personal experience of minority groups within the larger culture that can be indifferent, fearful, and at times harmful • An understanding of the concepts of marginalization and fractionalization as they apply to minority groups • An understanding of the intolerable intra-psychic tension and sense of worthlessness experienced by some members of minority groups that can also be a concomitant aspect of substance abuse

22. ...a Few More Factors for Consideration • The ability to recognize and challenge cultural biases and stereotypes encountered when reviewing and considering models of prevention • The capacity to apply cultural concepts of pain, illness, wellness, and recovery to prevention • A recognition of the need for treatment and prevention professionals from minority groups who can model and reinforce positive images

23. …and Finally, a Few More • A willingness to explore styles of communication with and among minority groups as well as to gain an understanding of their non-verbal behaviors • Ongoing exploration and understanding of one's own cultural background and its significance to cross-cultural situations • Recognition and validation of persons served through meaningful cultural celebrations and events that are inspiring and meaningful

24. Next Steps: • Module One: Exploring and Defining Diversity (posted 3/26/10) • Module Two: Organizational /Coalition Processes (posted 4/2/10) • Action Planning Tool for Identifying Priority Areas and Leverage Points (posted 4/2/10) • Module Three: Inclusivity in Community Planning and Prevention Programming (posted 4/9/10) • Review of process and resources during Individual TA Calls (scheduled for 4/14/10 - 4/15/10 and 5/12/10 – 5/13/10) • Submission of action plan (due 5/21/10)