cultural competence

blindness

acting as if the cultural differences do not matter or as if there are not differences among/between cultures; "everyone learns the same"; "our school does not need to focus on multicultural education - we have no diversity"

how do we become better?

ask open ended questions

2010 data on poverty

1. 15% of the US households live below poverty 2. female-headed households are associated with poverty 3. decreased access to transportation 4. lack of housing, unsafe environmental conditions 5. inadequate food sources

cultural competence is NOT

1. abandoning your own culture (to become a member of another culture) 2. giving us permission to make broad generalizations (intra vs inter ethnic diversity)

characteristics of culturally competent therapists:

1. acknowledge immense influence of culture (ethnocentric) 2. vigilant in awareness of dynamics that result in cultural differences (minimize misinterpretation/judgement) 3. expand cultural knowledge into everyday practice (ask) 4. adapt to diversity (develop questions/exam techniques) *do not assume; when it doubt, ask!

diversity dimensions

1. age 2. race 3. gender 4. sexual orientation 5. ethnicity/nationality 6. mental/physical ability 7. socioeconomic status 8. religion

4 stages of cultural competency

1. awareness 2. knowledge 3. skills 4. have a cultural encounter

end of life issues: elderly chinese

1. bad omen to discuss death 2. honor spoken word

end of life issues: asian/hispanic latino

1. belief in fatalism 2. may take away hope

6 points along the cultural continuum

1. cultural destructiveness 2. cultural incapacity 3. cultural blindness 4. cultural pre-competence 5. cultural competency 6. cultural proficiency

cultural factors

1. ethnic identification 2. socioeconomic status 3. migration history

what is cultural competency?

1. is it cultural awareness? 2. is it cultural sensitivity?

communication/learning styles

1. is your clinic welcoming? are the magazines and pictures in different languages too? 2. exercises translated - translated messages at the front desk/receptionist area? 3. take notes vs "hearing and feeling"

what if we do not become culturally competent?

1. miscommunication is ensured 2. goals for our patients aren't accurate 3. assistance at home is problematic 4. diagnoses may not be accurate 5. appropriate treatment may not be maximized

2015 census

1. over 44% of the US population belongs to a minority group 2. additionally, over 50% of our GEN X (or Millennial generation is in a minority group) - this will continue to grow

pain beliefs

1. pain responses can be guided by cultural rules 2. extensive intra culture variances in regards to pain 3. polish group studied - complained the least about pain 4. Italian Americans are permitted to "complain"

other forms of communication

1. personal space? 2. touch 3. members of the opposite sex 4. hand shake? 5. be aware of how to interact with persons of a different cultural background regarding these aspects

cultural competency is

1. recognition (awareness) 2. you care about it (value it) 3. requires skill (take action and incorporate into practice) *cultural competency is integrating all of these things and applying them to our practice

personal characteristics of therapists

1. sense of adventure 2. patience 3. flexibility 4. tolerance for ambiguity 5. sense of humor 6. cultural sensitivity *know how to adapt to certain situations, do not have to have all of these characteristics

culture bound syndromes

1. susto or "shock" (latin american) 2. anorexia nervosa 3. "arrested pregnancy syndrome" - Haitian/infertility/perdition

essential elements of cultural competency

1. value diversity 2. capacity for cultural self assessment 3. be conscious of inherent dynamics when cultures interact 4. institutionalize cultural knowledge 5. develop adaptations to service delivery to reflect understanding of diversity

examples of open ended questions

1. what do you call your problem? 2. what do you think caused it? 3. why do you think it started when it did? 4. what does your sickness problem do to you? 5. how severe is it? will it have short/long course? 6. what do you fear most about your sickness? 7. what are the problems your sickness has caused you? 8. what kind of treatments do you think would be most helpful? 9. what are the results you expect to receive from treatment?

incapacity

believing in the superiority of one's own culture and behaving in ways that disempower another's culture; "my way or the highway"; "his mom told me that he was developmentally delayed, so we can't expect him to do well"

poverty: a direct correlation between...

class and health; this affects world view/health and increased access to health care

what do culture brokers do?

connect patients----traditional healers-----mainstream health care system

skills

developing behaviors in order to interact with members of another ethnic or religious group while being sensitive to the culture

awareness

developing sensitivity and understanding of another ethic or religious group; usually involves internal changes in terms of attitudes and values

poverty: what is even more important?

education and health; decreased incidence of smoking and decreased incidence of obesity

proficiency

esteem culture, knowing how to learn about organizational culture; interacting effectively in a variety of cultural groups; "knowing how to differentiate to the needs of others"

knowledge

familiarization with selected cultural characteristics, history, values, belief systems and behaviors of the members of another ethic or religious group

work experience

have there been moments when a PT has to apply their cultural competency "skill" to communicate with the patient or for service delivery?

competence

interacting with others using the five essential elements of cultural proficiency as the standard for behaviors and practice; "looking at another's perspective through another lens"

end of life issues: orthodox jews/christian scientists

no autopsy

pre-competence

recognizing limitations of one's skills or an organization's practices when interacting with other cultural groups; "we offer a cultural diversity class at work"

what are culture brokers

someone who can facilitate the border crossing of another person or group of people from one culture to another; can bridge/link/mediate between groups

encounter

the actual interaction with a member of another ethnic or religious group and applying culturally sensitive skills

destructiveness

using one's power to eliminate the culture of another; "if we could get rid of those special needs kids, then our school scores would improve"