Learning Goals

3. Learning Goals Learners will: • Describe service delivery communication styles of various racial groups ; • Describe the principles of health literacy; and • List tips for working effectively with interpreters.

4. Service Delivery Style – African Americans • African Americans • Appraisal – Guarded, signs of genuineness, approachability and authenticity • Investigative/equalization of differences – determines the experience of the provider by challenging personal qualifications, values and beliefs • Partial identification with providers – If satisfied with stage 2, client personalizes with the provider • Loyalty/personal regard for provider - If provider responds appropriately, client becomes less defensive and less testing of provider intentions • Engagement – Trust established and full involvement begins • Expressiveness, individuality, creativity, sense of humor

5. Service Delivery Style – Hispanic Americans • Hispanic Americans • Respecto – respect by younger for older persons, women to men, persons in authority or higher socioeconomic status • Personalismo – preference for informal, personal, individualized attention • Platicando – leisurely chatting to establish a warm accepting atmosphere • Confianza en confianza – mutual trust relationship intimacy, personal involvement

6. Service Delivery Style - Native Americans • Preexisting social relationship with someone in the community provides increased trust • Traditional - May prefer chairs to be next to each other to avoid eye contact • Common basing - Informal chit chat on topics of mutual interest • Identification of mutual friends and acquaintances • Client needs to be satisfied that the provider has knowledge of his or her tribal history and group history

7. Service Delivery Style – Asian Americans • “Face saving” – acting in such a way as to protect someone’s dignity • Credibility of role relationships • Symbolic gift giving • Sometimes considered disrespectful to ask questions

8. Service Delivery Style – White Americans • Comfortable in asking questions • Rational – calm and quiet • May separate mind from emotions, may masks true feelings • Less bodily gestures • Emphasis on speaking clearly, precisely and consistently

9. Youth Culture - Text Abbreviations • What do these text abbreviations mean? • HMU • WUT • IDK • KK • IDC • NVM • NP • POS • PAL • GTG • 420 • RU 429

10. Text Abbreviations • What do these text abbreviations mean? • HMU – Hit me up • WUT - what • IDK- I don’t know • KK - ok • IDC – I don’t care • NVM - never mind • NP – no problem • POS – parent over shoulder • PAL – parents are listening • GTG – got to go • 420 – marijuana • RU 429 – Are you gay

11. Youth H.E.E.A.D.S.S. Assessment

12. Communication Strategies Title Goes Here

13. Health Literacy Health Literacy is …..“the ability to read, understand and act on health information.” Centers for Disease Control Health Literacy Guidelines 1. Ensure public health information and services are appropriate, actionable, and easy to understand and use. 2.          Involve representatives from your target audiences in planning, implementing, disseminating, and evaluating health information and services. 3.           Develop key partnerships to help facilitate change, influence behavior and generate interest in health literacy. 4.           Support changes to improve public health professionals' health literacy skills.

14. Health Literacy • Craft messages that are clear, simple and understandable. • Messages should be accurate. • Messages should be actionable.

15. Linguistic Competency The capacity of an individual to communicate effectively and convey information in a manner that is easily understood by diverse audiences including persons with limited English proficiency, low literacy skills and individuals with disability.

16. Linguistic Competency • Assess baseline understanding. • “Before we go on, could you tell me what you already know about applying for Medicaid? • Explain things clearly in plain language. • Avoid jargon. Avoid terms with different meanings. • Use open-ended questions. • Instead of asking “Do you have any questions?” say “What questions do you have?”

17. Linguistic Competency • Confirm understanding through teach-back. • This involves asking the family member to demonstrate their understanding of the information discussed. • Make it normal. “I do this with all my families.” • Put the burden on your shoulders. “I want to be sure I explained things clearly to you.” • Be specific. “We talked about how to make an appointment to apply for Medicaid. What is your understanding of our next steps?

18. Person-First Language • What is person-first language? • Linguistic expression to humanize people. • Sentence structure that names people first and the condition second. • Separating the “person” from the “trait.”

19. Person-First Language Exercise

20. Person-First Language Exercise

21. Cultural Competency….No!Nos! • Terms or Phrases to Avoid: • Ghetto • Redneck • Poor White Trash • N-word • C-word • Inappropriate jokes and stereotypes • Use strengths-based language • Use people-first language Labels are for clothing, not for people! Martina Navratilova

22. Phase One: Engagement Phase 2 1 3 Cultural Assessment Family’s Story Trust Building Engagement Phase

23. Wraparound & Culture Text box for copy Step 1 Engagement Step 2 Initial Plan Development Culture Step 4 Transitioning Step 3 Plan Implementation

24. Engagement 1 2 3 Empathy • Genuineness • “Being you” • Balance your para professional role and being yourself Respect “Believing there is value in each human being separate from any evaluation of his/her behavior” “Attempting to experience another person’s world then communicate an understanding of and compassion for the person’s experiences”

25. Listening Skills • Attentive Listening: You demonstrate interest by giving full attention to the speaker without interruption • Active Listening: You continue to show interest and in addition you summarize and ask clarifying questions. • Affirmative Listening: You listen for the person’s emotions and feelings. Your questions and responses show that you are validating the person. You demonstrate caring, empathy and respect.

26. Cultural Assessment: Part I Race/Ethnicity Religion/Spirituality Family Role Language Domains Migration Social Supports

27. Cultural Assessment: Part II Gender/Sexual Orientation Leisure Health Beliefs Socioeconomic Status/Educational Background Domains Neighborhood/Environment Nutrition

28. Sample Cultural Assessment Questions Race/Ethnicity Migration How would you describe your cultural background? Why did you leave your homeland? Family Role/Structure Language Tell me about your family. Who makes decisions in your family? Where? What language do you speak at home? What language are you most comfortable speaking? Religion/Spirituality Social Supports Is religion or your faith Important in your life? Is there a faith leader that you would like to be a part of our team? Who are your heros? Who were the last three visitors to your home?

29. Case Study You have been assigned to a foster care family that consists of a mother (Sandra Jones) and 2 boys that are part of the foster care system (Joshua ( 11) and Caleb Williams (15). The foster care mother practices the religion of Jehovah’s Witness and does not celebrate birthdays and holidays. The boys come from a Christian background and have traditionally celebrated birthdays and Christmas. The mother refuses to bring the boys to the Federation of Families Holiday Celebration. What questions would you ask from the cultural assessment? What is the foster care system’s guidance/recommendations on this cross-cultural issue? How should this issue be handled with the foster care mother? How do you balance family choice with the religious background of the Williams brothers?

30. Tips for Working with Interpreters • It is ideal to have a (pre-session) about your expectations, overview of meeting purpose, review forms that may be used, learn about the program • During group meetings, allow the interpreter to brief the family on the interpreter’s role within the context of visit. • During group meetings, it is important that one person speaks at a time to ensure that the interpreter is able to capture one voice at a time.

31. Tips • Eye contact is critical to relationship building with the family. Arrange yourself so that you, the family member and the interpreter are visible to one another (i.e. triangular)

32. Tips • Speak in a normal voice, clearly and not too fast.

33. Tips • Avoid jargon, acronyms and technical terms

34. Tips • Talk to the family using first person and a pause after a full thought for the interpretation to be accurate and complete.

35. Tips Don’t ask or say anything you don’t want the family to hear.

36. Tips • Be patient and avoid interrupting during interpretation. Be prepared to repeat yourself.

37. Tips • Debrief with interpreter to see if there is information that needs to be clarified or may have been communicated non-verbally by individual.

38. Tips • As a standard, family and friends should not be used to provide interpretation services.

39. Cross-Cultural Communication • Be non-judgmental. • Be aware of stereotypes you may have about cultural groups. • Treat people as individuals. • Determine whether expectations are real. • Empathize. • Check assumptions. • Be open to differences.

40. The Journey

41. Selena Webster-Bass, MPH The Voices Institute Cultural and Linguistic Competency Educator selena@voicesinst.org 904.504.9772