Developing a Self-Assessment Toolfor Culturally - Office of Minority ...

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COSMOS Corporation, October 2003 2-7StudyCross, et al., “Towards a Culturally CompetentSystem of Care: A Monograph on EffectiveServices for Minority Children Who are SeverelyEmotionally Disturbed,” 1989Adams, ed., Health Issues for Women of Color: ACultural Diversity Perspective, 1995Campinha-Bacote, “The Process of CulturalCompetence,” State of Washington, Departmentof Health, 1995Orlandi, ed., Cultural Competence for Evaluators:A Guide for Alcohol and Other Drug AbusePrevention Practitioners Working WithEthnic/Racial Communities, 1995Association of Asian Pacific Community HealthOrganizations, State Medicaid Managed Care:Requirements for Linguistically Appropriate HealthCare, 1996Lavizzo-Mourey and Mackenzie, “CulturalCompetence: Essential Measurements of Qualityfor Managed Care Organizations,” 1996National Maternal and Child Health ResourceCenter on Cultural Competency, Journey TowardsCultural Competency: Lessons Learned, 1996Tirado, Tools for Monitoring Cultural Competencein Health Care, 1996Andrulis, “Toward a More Culturally CompetentSystem of Care: Implications for Federal Policy,Managed Care Provider and Communities,” 1997McManus, ed., “Services to Minority Populations:Cross-cultural Competence Continuum,” 1998Source: CLAS in MCOs Study (OMH 2003b)Exhibit 2-1SELECT DEFINITIONS OF CULTURAL COMPETENCEAND CULTURALLY APPROPRIATE HEALTH CARE SERVICESDefinitionCultural competence: Organizations have formal policies, such as mission statements, specifically expressing acommitment to cultural diversity.Cultural competence: Cultural or ethnic competence refers to the development of skills that will help people behavein a culturally appropriate way with a given group, demonstrating both sensitivity to cultural differences and similaritiesin the effective use of cultural symbols in interactions and effective communications with members of diversepopulations. (The definition continues.)Cultural competency: “a set of behaviors, attitudes and policies of a system, agency or individual that enables thatsystem, agency or individual to function effectively in trans-cultural interactions...and a person’s or programs’s abilityto honor and respect the cultural differences (beliefs, interpersonal styles, attitudes and behaviors) of individuals andfamilies who are clients, staff administering programs, and staff providing service at state and local levels. In doingso, it incorporates values at the levels of policy, administration, and practice.”Cultural competence: a set of academic and interpersonal skills that allow individuals to increase theirunderstanding and appreciation of cultural differences and similarities within, among, and between groups. Thisrequires a willingness and ability to draw on community-based values, traditions, and customs, and to work withfocused interventions, communications, and other supports.Culturally appropriate services: “effectively identify the health practices and behaviors of target populations todesign programs, interventions, and services which effectively address cultural language barriers to the delivery ofappropriate and necessary health care services.”Cultural competence: the integration of 1) health-related beliefs and cultural values; 2) epidemiology; and 3)treatment efficacyCultural competency: “a program’s ability to honor and respect beliefs, interpersonal styles, attitudes, and behaviorsof families who are clients, as well as the multicultural staff who are providing services. It incorporates these values atlevels of policy, administration, and practice.” Cultural competency is viewed as a continuum, not as a one-time goal.“Competency implies skills which helps to translate beliefs, attitudes, and orientation in action and behavior in the dailyinteraction with children and families.”Cultural competency: level of knowledge-based skills required to provide effective clinical care to patients from aparticular racial or ethnic groupCultural competency: “effectively incorporating the ethnic/cultural characteristics of individuals and their health careneeds and in promoting health, and working to achieve the highest quality care.”Cross-cultural competency: “the knowledge and interpersonal skills that allow providers to understand, appreciate,and work with individuals from cultures other than their own. It involves an awareness and acceptance of culturaldifferences, self-awareness, knowledge of the patient’s culture, and adaptation of skills.”
2.1.6 Identifying Key Components of CLASSeveral characteristics or services emerged from the literature as important for healthcare agencies to be considered “culturally competent.” These key components for culturalcompetence (described below) provided the basis for adopting the MCOs study conceptualframework (with eight assessment domains) that is detailed in Section 2.2.Organizational Governance and Policy Development. To be considered “culturallycompetent,” health care organizations should have formal policies such as written missionstatements that specifically express a commitment to cultural diversity (Cross et al. 1989)and policies governing translation and interpretation services (The Asian and PacificIslander American Task Force [APIATF] 1997; National Public Health and HospitalInstitute [NPHHI] 1998). Community members should be recruited for policy-makingpositions, such as general oversite committees and task forces, and should be wellrepresented on new task forces that can be created to study, evaluate, and address issuesrelated to culturally appropriate care (Cross et al. 1989; Roberts et al. 1990). Strategicplanning committees and other decision-making bodies should be representative of thecommunity, in race and ethnicity, as well as other characteristics such as gender and age(APIATF 1997; National Latino Behavioral Health Workgroup [NLBHW] 1996;Washington State Department of Health 1998).Culturally Inclusive Health Care Environment and Practices. An importantstrategy for addressing the health care needs of culturally diverse populations is torecognize and learn about a patient’s perspective concerning illness (Randall-David 1989).Understanding cultural perceptions about disease is critical to effectively engagingindividuals in disease prevention and treatment activities (Frye 1993; Saint-Germain andLongman 1993). Also, providers’ understanding of cultural differences in familialrelationships and roles is often important for effective treatment plans (Ahn and Gilbert1992). Moreover, health care providers may collaborate with traditional healers to learnmore about patients’ use of traditional healing methods in an effort to provide moreculturally competent care (APIATF 1997; NLBHW 1996) and utilize practices that arerespectful of and responsive to patients’ cultural backgrounds, e.g, diverse religiousservices and facilities or dietary options available (NPHHI 1998).Also important for culturally competent care are providers’ awareness about theirown values and how they may bias interactions with individuals from different cultures(Dilworthanderson et al. 1993; Eliason 1993; May 1992). To improve patient care,providers are encouraged to assess their own beliefs and have knowledge of generalethnic, regional, and religious beliefs and practices before discussing health care issueswith patients (Price and Cordell 1994).COSMOS Corporation, December 2003 2-8
Page 1 and 2: Developing a Self-Assessment Toolfo
Page 3 and 4: ContentsChaptersPage1. Introduction
Page 5 and 6: Chapter 1Introduction
Page 7 and 8: While many LPHAs currently provide
Page 9 and 10: LPHAs include: adult and child immu
Page 11 and 12: Professions Education Partnership A
Page 13 and 14: Chapter 2Methodology for Developing
Page 15 and 16: Public Health Practice Program Offi
Page 17 and 18: assess their own beliefs and have k
Page 19: communicate with, and clearly under
Page 23 and 24: Given these persistent disparities
Page 25 and 26: (Exhibit 2-2, Continued)DOMAIN / KE
Page 27 and 28: limited to the actual clinical enco
Page 29 and 30: Chapter 3Project Results and Recomm
Page 31 and 32: local board of health. PEP and PAG
Page 33 and 34: numerous promising CLAS practices a
Page 35 and 36: References
Page 37 and 38: Becker, M.H., and L.A. Maiman, “S
Page 39 and 40: Frye, B., “Health Care Decision M
Page 41 and 42: Marin, G., “Defining Culturally A
Page 43 and 44: Perkins, Jane, “Overcoming Langua
Page 45 and 46: U.S. Bureau of the Census, “Censu
Page 47 and 48: Appendix AMembership Lists of the P
Page 49 and 50: Appendix A-1Developing a Self-Asses
Page 51 and 52: Appendix A-2Developing a Self-Asses
Page 53 and 54: Appendix B-1Overview of Eight CLAS
Page 55 and 56: Domain 3: Culturally Inclusive Heal
Page 57 and 58: understanding of diversity issues i
Page 59 and 60: Appendix B-2Conceptual Framework fo
Page 61 and 62: Appendix CLPHA Director or Designee
Page 63 and 64: Pre-Interview Script for LPHA Direc
Page 65 and 66: 3b. Which of the following are refl
Page 67 and 68: 6. Does your agency have a formal p
Page 69 and 70: 10. Which of the following describe
Page 71 and 72:
Post-Interview Script for LPHA Dire
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Appendix DStaffing Questionnaire
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A. QUALITY MONITORING AND IMPROVEME
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B. MANAGEMENT INFORMATION SYSTEMS (
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7. Please indicate, if you know, th
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1c. Please indicate for which categ
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6. Please indicate for which catego
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10. Which of the following topical
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17. Which of the following benefits
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4. Which of the following strategie
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Appendix EClient Services Questionn
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A. QUALITY MONITORING AND IMPROVEME
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6b.Which of the following community
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3. Please report or estimate what p
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3. Which of the following practices
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Oral Interpretation Services10. Whi
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16. At which of the following key e
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3. Which of the following kinds of
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Appendix FPilot Test Response Form
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RESPONDENT EVALUATIONOF THE QUESTIO
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Appendix GCLAS in MCOs Study Data C
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position, as titles will likely var
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complex and uncertain at the time t
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1. Incorporate a confirmation pre-c
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Exhibit 2DATA COLLECTION PROCESSSen
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