Implicit Bias, Diversity, and Cultural Competence

What is Kleinman's Explanatory Model?

-Asking your patient/client questions -Ex: "Where do you think this is going?" -Ask about illness, fear -Why illness is happening -Ex: "How can I help you?"-> important to get to similarity

What is cultural competence?

-Cultural differences are accepted and respected. -There is CONTINUOUS EXPANSION of cultural knowledge, and resources and services are continually adapted. -There is CONSTANT VIGILANCE regarding the dynamics of cultural differences.

Cultural Competence

-Differences respected, knowledge expansion. -Barriers pushed aside

Cultural Proficiency

-High regard, research on new approaches continual -Really involved; doing research and better processes, don't have to be this to be competent

What does perceived personal similarity lead to?

-Higher ratings of trust, satisfaction, and intention to adhere.

What does LEARN stand for?

-Listen -Elicit pt's health beliefs -Assess and investigate potential attributes and problems -Recommend realistic changes -Negotiate

Micro-assault

-Most likely conscious; deliberate; "old fashioned"

What is an explicit bias?

-Operates at level of consciousness -Operate within belief system -Actions taking to divide -Ex: hiring practices

1998: Advisory Board to the President's Initiative on Race

-Racism one of the most divisive forces in society -Racial legacies of the past continue to haunt current policies and practices that create unfair disparities between minority and majority groups. -Racial inequities are so deeply ingrained in American society that they are nearly invisible. -Most White Americans are unaware of the advantages they enjoy in society and of how their attitudes/actions unintentionally discriminate against people of color

What happens to the receiver when a microaggression happens?

-Sapping of psychic/spiritual energy ("did this just happen?") -Increased self-doubt -Increased frustration -Diminished self-efficacy/resiliency -Diminished achievement of potential (students of any age; believe they can't make it) -Feelings of "invisibility"/isolation

Consumer Centric

-To ensure best practice by responding to individual and cultural considerations, needs, and values.

Cultural Pre-Competence

-Use appropriate responses to cultural differences -Awareness that there's some processes to improve

How do you overcome implicit bias?

-Your team/my team -Instinct: in-group versus outsider -Rational deliberation overcomes instincts -Be rational and deliberate before taking action -Harvard tests designed to make you aware of your preferences

How do we get to perceived personal similarity?

1. Recognize our biases (insensitivity; paternalistic) 2. Recognize the individual patient (specifics of lives, know who to speak to, ask for permission first before beginning) 3. Challenge yourself to develop a relationship with your patient. 4. Delivering high quality care means asking questions. (Ex: be open and ask something you might not know)

5 Essential Elements of Cultural Competence

1. Value diversity 2. Have the capacity for cultural self-assessment 3. Be conscious of the dynamics inherent when the cultures interact. 4. Institutionalize cultural knowledge. 5. Adapt service delivery reflecting an understanding of diversity between and within cultures.

What questions should we consider about diversity?

1. Which items are we not supposed to talk about? 2. Which items can we easily form opinions/make assumptions about? (all of them) 3. If we form opinions is it possible that we may alter our decisions/actions as a PT?

Advocacy

Adopt best practice standards and approaches, and ensure that systems are built to be fair and equitable.

What are the primary dimensions of diversity?

Age, race, sex, sexual orientation, ethnicity, mental/physical ability, socioeconomic status, religion

What are microaggressions?

Commonplace, subtle, and often automatic "put downs" and insults directed at any diversity component -A human trait instead of an American trait

Microinsult

Communications that convey rudeness/insensitivity that demean a person's identity; most likely unconscious -Ex: "What does your hair look like today?" as your rip headband off -Ex: People of color won't understand explanations of what's wrong with them, and you are surprised when they do.

Micro-invalidation

Communications that exclude, negate, or nullify the psychological thoughts, feelings, or experiential reality of a person -Often invisible to majority group -Ex: When a person of color calls a (white) doctor that you respect "racist" and you dismiss it

Cultural destructiveness

Dehumanize, explicit bias -Overtly trying to destroy culture

What is an implicit bias?

If we make decisions or take actions based upon assumptions or biases -We are likely unaware. -Contradict our stated beliefs -Grounded in the human tendency to divide people into groups.

Cultural incapacity

Ineffective relationships, stereotypes, paternalistic -We know our way and this is how we do it -"Our way or the highway"

What is culture?

The INTEGRATED patterns of human behavior that include thoughts, communications, actions, beliefs, customs, as well as institutions of racial, ethnic, religious, or social groups -integration makes implicit bias/microaggressions possible

What is the method to improve awareness and communication?

The LEARN model

What is a solution to microaggressions?

To openly engage people in a dialogue about any diversity component-> to make "invisible" visible

Cultural Blindness

Treat everyone the same way -Ex: "I didn't see you as black" -One size fits all approach

What are the secondary dimensions of diversity?

Work background, income, marital status, geographic location, family background, education

Access/Equity

Work to ameliorate disparities and inequities in the healthcare system

What is diversity?

the condition of having or being composed of DIFFERING elements