cultural diversity training for nc public health nc office of minority health and health disparities
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CULTURAL DIVERSITY TRAINING FOR NC PUBLIC HEALTH
NC OFFICE OF MINORITY HEALTH AND HEALTH DISPARITIES
Developed by
Office of Minority Health and Health DisparitiesNC Department of Health and Human Services
Raleigh, NC
and
Forest Toms, PhDTraining Research & Development, Inc.
Hickory, NC
Goal of Training
To build the foundation for culturally appropriate health services capable of serving an increasingly diverse population.
WORKSHOP OBJECTIVES
Participants will have an opportunity to:
Increase awareness of their own cultural understanding
Increase awareness of cultural issues when working with minority communities
Learn about changing demographics which are challenging health services
Training Overview
Changing demographicsSelf awarenessAwareness of cultural differencesSocialization patternsRole of value and beliefsOverview of framework for developing cultural competence
“When we think…
of Culture, we think of mainstream America; but when we think of Diversity the tendency is to think of minority groups.”
“American Culture”
White middle – class valuesDominant cultureMainstream cultureEuropean – American (Anglo)
OVERVIEW OF CULTURAL AWARENESS
MULTICULTURAL PROCESS
AWARENESS
KNOWLEDGE
DEVELOPMENT OF SKILLS
ASSUMPTIONS AND APPROACHES TO DIVERSITY
DIVISIVE/PANDORA’S BOX
ONLY BLACK/WHITE
NOT AN ISSUE
SHOULD TREAT EVERYONE THE SAME
RESOURCES
ALREADY DEALT WITH
“Why” of Diversity
What’s In a Name?
African American – Black, Africans, CarribeansHispanic/Latino – Mexican, Peurto Rican, Cuban, Salvadorian, Equadorian, Argentian, Honduran, Dominican, etcEuropean/Anglo – WhiteAmerican Indian – Native American, Alaska Native, AleutianAsian – Chinese, Filipino, Korean, Japanese, Vietnamese, Cambodian, Laotian, Hmong, Pacific Islander (Polynesian, Melanesian, Mecronesian)
USUS Population Composition 1990 - 2050
75.6
60.5
52.8
11.8
13.1
13.6
9.1
18.9
24.5
2.8
6.7
8.2
0.7
0.8
0.9
0 10 20 30 40 50 60 70 80
American Indian
Asian/Pacific IslandHispanic
Black
White
American Indian
Asian/Pacific Island
Hispanic
Black
White
Percentage of US Population
2050
2030
1990
Source: U.S. Census Bureau
American Indian
Asian/Pacific Island
Black
Hispanic
White
POPULATION PROJECTIONS for 2030(US Census Bureau)
Population increases:
White Americans 25%
African Americans 68%
Asians Americans, Pacific Islanders, American Indians 79%
Hispanic/Latinos 187%
North Carolina Racial and Ethnic Minority Population, 2000 Census
Black21.4%
American Indian1.2%
White70.2%
Asian1.4%
Hispanic4.7%
Other1.1%
North CarolinaNorth Carolina Differences in Population by RaceDifferences in Population by Race
TRD,Inc. All Rights Reserved
0
10
20
30
40
50
60
70
80
White Afr. Am Hisp Asian Amer.Ind
19902000
“What” of Diversity
Dimensions of Diversity
Primary– Largely unchangeable human differences– Inborn– Influence our early socialization
Secondary– Can be changed– Differences we acquire, discard and modify
throughout our lives
Primary Dimensions of Diversity
Sexual/AffectionalSexual/AffectionalOrientationOrientation
UnchangeableDifferences
AgeAge
RaceRace
PhysicalPhysicalAbilities/QualitiesAbilities/Qualities
GenderGenderEthnicityEthnicity
TRD,Inc. All Rights Reserved
Secondary Dimensions of Diversity
EducationalBackground Geographic
Location
Income
Marital Status
MilitaryExperience
HouseholdComposition
ReligiousBeliefs
Work Experience
TRD,Inc. All Rights Reserved
Defining andDefining and UnderstandingUnderstanding
CULTURE
CultureCulture Behavior patterns, arts, beliefs,
institutions, and all other products of human work and thought American Heritage Dictionary, 1991
A view of the world and a means of adapting to the world Bilingual Health Initiative Task Force, 1994
Is reflected in, and influences beliefs and values, communication styles, health beliefs and practices
Culture
Integrated Pattern Of Behavior
ThoughtThought
ArtifactsArtifactsActionAction
SpeechSpeech
Culture Helps Us…
Organizes Our Physical
And Social Interaction
Forms Our
Identity Shapes Our
Understanding
And Perceptions
Culture Defines
Family Roles
Family Relationships
Family Structure
Attitudes
And
Practices
Styles Of
Communication
Beliefs
Political
Economic
Goals
CultureCulture
Views OfTruth
SocialRelationships
Visual
Arts
Literature
Actions
PersonalHabits
CommunicationStyles
Performing
Educational
Social
ExperiencesBeliefs
Includes
Includes
Includes
Includes
Includes Includes
Reflects
May Result In
Influences Influences
Concepts: CultureConcepts: Culture
Beliefs and Values
Beliefs and Values
What we are used to thinking and doingWhat we feel or know is right, good , importantComplex concepts with many dimensionsInfluence all other area of life and activityAffect how people think, feel, actCan cause conflict if people’s beliefs and values are not incorporated in health recommendations
Beliefs Concept Map
Views Of Truth
Religion
Supernatural
BeingsGod
Human Nature
Values
One
Redeemable
ManyBad
Good
BeliefsBeliefs
InterpersonalRelations
TimeOrientation
Focus Of Human Activity
RelationshipWith Nature
Influence
Include
Include
Include
May BeConsidered
MayInclude
May Focus On
May Be Perceived As
Include Influence
Overview of BeliefsComparison of Common Values
Anglo-Americans– Mastery over nature– Personal control over the environment– Doing-activity– Time dominates– Human equality– Individualism/privacy– Youth– Self-help– Competition– Future orientation– Informality– Directness/openness/honesty– Practicality/efficiency– Materialism
Other Ethnocultural Groups– Harmony with nature– Fate– Being– Personal interaction dominates– Hierarchy/rank/status– Group welfare– Elders– Birthright inheritance– Cooperation– Past or present orientation– Formality– Indirectness/ritual/”face”– Idealism– Spiritualism
Culture and Healthcare
Patients
Health Status – Minority Groups
High risk for :– Heart disease, diabetes, cancer,
homicides, infant mortality – African Americans
– Stroke/diabetes, MVA, infant mortality American Indian
– Diabetes, MVA, homicide - Hispanics
– Diabetes - Asians/Pacific Islanders
Teen pregnancy– African Americans– American Indians– Hispanics
Barriers to Health Services
High rates of povertyUnemploymentCost of careLack of insuranceLocation and hours of servicesLack of transportationLack of informationLanguageCultural differences between providers and clients
Visions of a Culturally Competent Healthcare System
Definition of Cultural Competence
The process is ongoing and continuous.
Cultural competence is a dynamic, developmental process and a state towards which we should strive, it takes a long-term and consistent commitment to achieve.
It is not something that comes to the individual,the agency, or the system through a one-shot, quick-fix approach.
MOVING TOWARDS THE GOAL
In order to move towards cultural competence, there must be a willingness and courage to confront all the feelings and attitudes that cultural competence and change indicate for the individual, the agency, and society in general.
As Pinderhughes (1989) states, the multicultural staff
engages in dialogue about their differences in perceptions and experiences.
OUTCOMES
Failure to provide the opportunity to understand and process these differences among a multicultural staff can produce two outcomes:
staff will cover over the conflict in perceptions and orientation and block off the confusion, frustration, and strong feelings.
conflict can erupt and staff will become burned out and fatigued.
BEFORE TAKING ACTION
Before developing programs and policies, agencies should
understand cultural dynamics and the significance of cultural identify for themselves, their clients, and their work together.
Opportunities for sharing and dialogue must be built into the structure of the agency or organization seeking to become more culturally competent.
UNDERSTANDING THE AGENCY ENVIRONMENT
As part of the agency’s commitment, it should be recognized that cultural diversity and cultural competence require an understanding of the sociopolitical environment in which an agency operates.
Cultural Competency Continuum
Cultural destructiveness -- attitudes, policies, and practices that are harmful to cultures and hence to individuals within the culture.
Cultural incapacity -- the system or agencies lack(s) the capacity to help minority clients or communities. There is much bias.
Cultural blindness -- the system and agencies provide(s) services with the belief that they are unbiased. The premise is that services are universally applicable.
Cultural Competence Continuum continued
Cultural pre-competence -- agency recognizes its limitations in serving minorities and tries to improve services for a specific population.
Cultural competence -- agencies are characterized by acceptance and respect for difference, continuing self-assessment regarding culture, careful attention to the dynamics of difference, continual expansion of cultural knowledge and resources, and various adaptations to service models to better meet the needs of minority populations.
Cultural proficiency -- advanced cultural competence. Characterized by holding culture in high esteem.
QUIZ1. T or F Race, age, gender and ethnicity are primary diversity differences that
cannot be changed.2. T or F Cultures have the same beliefs and values.3. Thought, artifacts _________ and ___________ are integrated patterns of
culture behavior.4. T or F High poverty rates is not a barrier to health services.5. T or F This agency should recognize that cultural diversity and cultural
competence require an understanding of the socio-political environment in which it operates.
Name:_________________________________ Date:__________________
(Fax Quiz to Wanda Vaughan, Personnel Officer at 358-7869)
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