am v5 series 4
TRANSCRIPT
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OCTOBER 2002 VOLUME 5, ISSUE 10 PLEASE COPY OR POST
Ideas for Treatment Improvement
Cultural Competence Issues
Northwest Frontier
Addiction Technology
Transfer Center
3414 Cherry Ave NE, Suite 100Salem OR 97303
Phone: (503) 373-1322
FAX: (503) 373-7348
A project of
Oregon Health &Science University
Steve Gallon, Ph.D.,Project Director
Mary Ann e Bryan, [email protected]
Be sure to check out
our web page at:
http://www.open.org/nfatc
Unifying science,
education and
services to
transform lives
Our most basic common l ink is
that we all inhabit thi s planet. We
all breathe the same air . We all
cheri sh our children s futur e. And
we are all mor tal.
John F . Kennedy (1917-1963)
The next three issues of the Addic-
tion Messenger will focus on
information regarding cultural
competency issues for counselors and
treatment organizations. As a substance
abuse professional the client population ofyour agency is probably representative of
demographics of our society. Society
today is both multi-ethnic and
multicultural. You may have questions
about your clients culture and how you
can become more culturally sensitive or
how your agency can develop cultural
competency. This series of articles will
address these questions.
Ethnic and cultural disparities exist in
many aspects of our society includinghealth care. Culture influences the way
clients respond to health care provision
and can impact the delivery of those
services. In order to better respond to
client needs, treatment programs and
substance abuse professionals can foster
their understanding of diversity and
further their appreciation and acknowledg-
ment of the differences in their clientele.
The following paragraphs will provide
definitions for terminology related to
culture. Cross, T. (1989) gives the
following definitions:
Cultur al Knowledge
Familiarization with selected cultural
characteristics, history, values, belief
systems, and behaviors of the members of
another ethnic group
Cul tural Awareness
Development of a sensitivity and under-
standing of another ethnic group. This
involves internal changes in attitudes and
values and refers to qualities of openness
and flexibility in relation to others. Cul-tural awareness must be supplemented
with cultural knowledge.
Cul tur al Sensitivity
Knowing that cultural differences as well
as similarities exist, without assigning
values (better or worse, right or wrong) to
those cultural differences.
Cul tur al Competence
A set of congruent behaviors, attitudes
and policies in an agency that enable that
agency to work effectively in cross-
cultural situations. Culture implies the
integrated pattern of human thoughts,
communications, actions, customs,
beliefs, values, and institutions of a racial,
ethnic, religious or social group. Compe-
tence implies having a capacity to
function effectively. Cultural compe-
tency emphasizes the idea of effectively
operating in different cultural contexts
while cultural knowledge, awareness and
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NFATTC ADDICTION MESSENGER OCTOBER 20022PAGEsensitivity do not include this
concept.
Culture
A groups shared conception of
reality, created by members of the
group living together over genera-tions, through their language,
institutions, arts, values, beliefs,
experiences, work and play.
Sub-Culture
A group of people within a larger
sociopolitical structure who share
cultural characteristics which are
distinctive enough to distinguish it
from the others.
EthnicityThe way in which groups of people
retain and practice customs,
language, and social views of their
group.
Cultivating Cultural
Competence
On an individual level within your
agency there are several things that
can be done to cultivate cultural
competence:Value diversity by considering
differences as strengths rather than
interact. Individuals may not feel
in their comfort zones but it should
not cause division.
Institutionalize cultural knowl-
edge through the encouragement of
the agencys administration.
Adapt the delivery of services to
reflect an understanding of cultural
diversity through making changes
to meet the needs of your clients.
Models of Cultural Com-
petence
A culturally competent model of
treatment acknowledges the
cultural strengths, values and
experiences of the client whileencouraging behavioral and
attitudinal changes. Characteristics
of culturally responsive services
include:
Staff knowledge of the native
language of the client,
Staff sensitivity to the cultural
nuances of the client population,
Staff that is representative of the
population,
Treatment services that reflect
cultural values and treatment needsof the client population, and
Representation of the client
population in decision making and
policy implementation within the
agency.
The culturally competent agency
should implement cultural compe-
tence at various levels within the
agency, such as attitude, practice,
policy and procedure.
Josepha Campinha-Bacote (2002),
Ph.D., RN, wrote an article titled
The Process of Cultural Compe-tence in the Delivery of Healthcare
Services which describes a new
model of cultural competence.
The key points of this model
include five constructs of cultural
competence:
Cul tural Awareness the process
of conducting a self-examination of
biases of other cultures and an in-
depth exploration of ones cultural
and professional background.Cultur al Knowledge process of
seeking cultural information as well
as biological variations among
specific ethnic groups.
Cultural Skill ability to conduct
a cultural assessment to collect
relevant cultural data regarding
clients concerns as well as con-
ducting a culturally-based physical
assessment.
Cultur al Encounter the process
which encourages the counselor todirectly engage in face-to-face
cultural interactions in order to
modify their existing beliefs about a
particular group to prevent stereo-
typing.
Cultur al Desir e- the motivation
to want to engage in the process
of becoming culturally aware,
knowledgeable, skillful and capable
of seeking cultural encounters.
Campinha-Bacote notes thatcultural desire is the pivotal
construct of cultural competence
that provides the energy source and
foundation for the journey towards
cultural competency.
Another model of cultural compe-
tence, offered by Dr. Terry Cross
(1989) at the University of Port-
land, Portland, Oregon, includes
cultural destructiveness as the
Diversity Patterns in Our Region
AK HI ID OR WA
Indian/Alaskan 15.6% .3% 1.4% 1.3% 1.6%
Asian .4% 41.6% .9% 2.9% 5.5%
African American 3.5% 1.8% .4% 1.6% 3.2%
Hispanic 4.1% 7.2% 7.9% 8% 7.5%
Hawaiian/Pacific Islander .5 % 9.4% .1% .2% .4%
tolerating them.
Conduct a cultural self-assess-
ment.
Be awareness of dynamics when
people from different cultures
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NFATTC ADDICTION MESSENGER OCTOBER 2002
Sources:
3PAGE
Cultural Competence:
Agency Awareness
Next I ssue:
lowest level of competency and
advanced competence as the
highest. The definitions are summa-
rized below.
Cultur al Proficiency engaging in
research about cultural variety and
differences.
Cul tur al competence accepting,
appreciating and accommodating
cultural differences. Including in-
formation for trainings that acknowl-
edges and values differences.
Pre-competence recognizing own
deficiencies in cultural awareness
and the importance of cultural
differences and awareness. Having
the commitment to correct the
deficiencies.
Cultur al blindness those individu-
als stating they are color blind and
dont see color.
Cultur al i ncapacity individuals
unable to accept or respond to
cultural diversity existing in a group.Cul tur al destructi veness relating
to culture in an anti-cultural way
through negative relationships with
other cultures or attempting to
eliminate them.
The Myth of Cultural Com-
petence?
In an article written by Ruth G.
Dean (2001) titled The Myth of
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Cross-Cultural Competence takes
a different view of cultural compe-
tence. The authors main concern
is how does a person become com-
petent at something (culture) that is
continually changing, and how do
we develop a focus that includes
ourselves as having differences,
beliefs, and biases that are inevita-
bly active? Dean concludes that
people working in cross-cultural
situations consider a model in
which maintaining an awarenessof ones lack of competence is the
goal rather than the establishment
of competence. With lack of
competence as the focus, a dif-
ferent view of practicing across
cultures emerges. She suggests
that reading about other cultures,
becoming informed of ones own
cultural baggage and trying to be-
come aware of when it interferes
with the ability to understand
anothers point of view is helpful
but that we must recognize how
difficult it is to separate ourselves
from our own cultural baggage.
Keeping that awareness in our
conscience will hopefully limit its
impact on our work.
Improving Patient Care (2000).
Cul tur al Competence. Retrieved
September 16, 2002, from
World Wide Web:
http://www.aafp.org/fpm/20001000/5&cult
Center for Substance Abuse Treatment
(1999). Cul tur al I ssues in Substance
Abuse Tr eatment. Rockville, Maryland
Transcultural Care (2002). The
Process of Cu ltu ral Competence in
the H ealth care Services. Retrieved
September 16, 2002, from
World Wide Web:
http://www.transculturalcare.net
Dean, Ruth, G. (2001) The Myth of
Cross-Cultural Competence Famili es in
Society: The Journal of Contemporary
Human Services, Vol. 82, No. 6, pp.
623-630 .
Cross, T. et al (1989). Towards a
Culturally Competent System of Care
Vol. 1, Washington, D.C.: Georgetown
University Child Development Center,
CASSP Technical Assistance Center
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complete the pre-test on the reverse side of this page, and return both to NFATTC with a feepayment of $25 (make
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series in 2002). You may complete as many series as you wish.
Series 1includes Vol. 4, Issues 1-3 Evidence-Based Treatment Approaches
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Program? and Naltrexone Facts
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Series 6 includes Vol. 5, Issues 4-6 Co-Occurring Disorders
Series 7 includes Vol. 5, Issues 7-9 Trauma Issues
______________________________________________________________________________
Registration Form for Series 8 - Cultural Competency Issues
Name______________________________________________________________
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City/State/Zip_______________________________________________________
Phone______________________________________________________________
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____ No high school diploma or equivalent ____ Associates degree ____ Masters degree
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Return your pre-test by mail or FAX at (503) 373-7348
Northwest Frontier ATTC
3414 Cherry Ave. NE, Suite 100, Salem, OR 97303
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Pre-TestSeries 8
Cir cle the corr ect answer for each question
#1
A set of congruent behaviors, attitudes and policies that
enable an agency to work effectively in cross-culturalsituations defines:a. Cultural awareness
b. Cultural competence
c. Cultural knowledge
d. Cultural sensitivity
e. None of the above
#2
A definition of ethnicity would include the way in which
groups of people retain and practice customs, language, and
social views of their group.
True False
#3
Characteristics of providing culturally responsive services
would include:
a. sensitivity to cultural nuances of the client population.
b. having staff that is representative of the population.
c. providing services that dont reflect cultural values.
d. none of the above
e. a and b
#4
Cultural competence:
a. does not influence the development of a treatment plan.b. does not facilitate the acccuracy of a diagnosis
c. allows the provider to obtain more specific and complete
information
d. b and c
e. all of the above
#5
Cultural competence:
a. improves the overall communication and clinical interac-
tions between client and provider.
b. leads to improved diagnosis and treatment plans.
c. does not lead to greater client compliance.
d. a and be. b and c
#6
Josepha Campinha-Bacote describes a new model of
cultural competence that includes only the following:cultural awareness, cultural sensitivity, and cultural skills.
True False
#7
In Ruth G. Deans article, The Myth of Cross-Cultural
Competence, she suggests :
a. maintaining an awareness of ones lack of cultural
competence is a goal.
b. that people dont have cultural bggage.
c. that it is difficult to become competent at something
(culture) that is continually changing.
d. a and b
e. a and c
#8
Josepha Campinha-Bacote notes that the pivotal construct of
cultural competence that provides the energy source and
foundation for the journey towards cultural competence
comes from:
a. cultural encounters
b. cultural desire
c. cultural knowledge
d. a and b
e. none of the above
#9
A culturally competent agency should implement cultural
competence at various levels such as:
a. agency attitudes
b. agency practices
c. agency policies and procedures
d. a and b
e. all of the above
#10
Becoming a culturally sensitive and responsive counselor is
best conceptualized as a process.
True False
Mail or FAX your completed test to NFATTC
Northwest Frontier ATTC, 3414 Cherry Ave. NE, Suite 100, Salem, OR 97303
FAX: (503) 373-7348
You can still register for continuing education hours forSer ies 1, 2, 3, 4, 5, 6 or 7
Contact Mary Anne Br yan at (503) 373-1322 ext. 224
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NOVEMBER 2002 VOLUME 5, ISSUE 11 PLEASE COPY OR POST
Ideas for Treatment Improvement
Northwest Frontier
Addiction Technology
Transfer Center
3414 Cherry Ave NE, Suite 100Salem OR 97303
Phone: (503) 373-1322
FAX: (503) 373-7348
A project of
Oregon Health &Science University
Steve Gallon, Ph.D.,Project Director
Mary Ann e Bryan, [email protected]
Be sure to check out
our web page at:
http://www.open.org/nfatc
Unifying science,
education and
services to
transform lives
Cultu ral competence is the
process of becoming;
not a state of being...
Josepha Campinha-Bacote, Ph.D.
This issue of the Addiction Messen-
ger focuses on issues that can be
important to increasing cultural
competence in substance abuse treatment
organizations. Since todays society is
becoming increasingly both multi-ethnic
and multicultural there is a need for
everyone to continue their growth ofknowledge in this area. A key aspect of
becoming culturally competent is to be
aware of the great diversity among
individuals, even in the smallest cultural
group. Populations include people from
different races, cultures, ethnic back-
grounds, religions, ages, genders, sexual
orientations as well as physical and mental
abilities.
Why Is Cultural Competence
Needed?
The National Center for Cultural Compe-
tence (NCCC) at Georgetown University
(1999) notes that the incorporation of
culturally competent approaches within
heath care systems remains a great
challenge for many states and communi-
ties. Organizations and programs are
struggling with how best to respond to the
needs of diverse groups. The need for
Cultural Competence: Agency Action
cultural competence in health care sys-
tems, according to NCCC, includes but is
not limited to the following observations:
* The perception of illness and diseaseand their causes varies by culture,
* Diverse belief systems exist related to
health, healing, and wellness,
* Culture influences help seeking behav-
iors and attitudes toward health care
providers,
* Individual preferences affect traditional
and non-traditional approaches to health
care,
* Patients must overcome personalexperiences of bias within health care
systems, and
* Health care providers from culturally
and linguistically diverse groups are under-
represented in the current service delivery
system.
These issues substantiate the need for
health care programs to develop policies,
practices and procedures that support the
delivery of culturally competent services.
The National Center for Cultural Compe-
tence has developed and outlined thefollowing six key reasons for the incorpo-
ration of cultural competence in organiza-
tions:
1. To Respond to Curr ent and Projected
Demographi c Changes in the United
States.
Data from the 2000 census notes that the
number of people who speak a language
other than English grew 48% during the
previous ten years. Within this group
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NFATTC ADDICTION MESSENGER NOVEMBER 20022PAGE21.3 million report having trouble
speaking English (an increase of
52% since 1990). Currently the
foreign-born population of the
United States is larger than it has
been in the last five decades and
the trend is expected to continue.
2. To El imi nate Long-Standing
Dispariti es in the Health Status of
People of Diverse Racial, E thni c,
and Cul tural Backgrounds.
The divisions of race, ethnicity and
culture are sharply drawn with
regard to health in the United
States. There continues to be
disparities in the incidence of illness
and death among diverse groups.
Six areas of health status have been
targeted by the Federal govern-
ment: cancer, cardiovascular
disease, infant mortality, diabetes,
HIV/AIDS, and child and adult
immunizations.
3. To Improve the Quali ty of
Services and H ealth Outcomes.
Differences among people can
stem from nationality, ethnicity,
and culture as well as family
background and personal experi-
ences. These differences affect
beliefs and behaviors related to
health issues of both clients and
providers. The provision of
culturally competent health care
services includes understanding of:
* Beliefs, values, traditions and
practices of a culture;
* Culturally-defined, health-related
needs of individuals, families andcommunities;
* Culturally-based belief systems
related to the etiology of illness and
disease and to health and healing;
and
* Attitudes towards seeking help
from health care providers.
4. To Meet Legislative, Regula-
tory and Accreditation M andates.
Organizations and programs have
multiple responsibilities to comply
with Federal, state and local
regulations in the delivery of health
services. The Healthy People Year
2000/2010 Objectives, among
other national efforts, includes an
emphasis on cultural competency
as an integral component of health
service delivery.
5. To Gain a Competi tive Edge
I n the Market Place.
Culturally appropriate treatment
services can increase retention and
access to care, expand recruitment
and increase the satisfaction of
consumers. Reaching these
outcomes can include integrating
culturally competent policies,
structures and practices within
agencies.
6. To Decrease the Likelihood of
Li abil ity/Malpractice Claims.
A lack of awareness about cultural
differences could result in liability.
Communicating with clients may
be even more challenging when
there are cultural and linguistic
barriers present.
The NCCC notes that there are a
lack of policies, planning proce-
dures and institutional structures in
many organizations that support
culturally competent practices. A
cultural competency framework
used by NCCC is based on the
following beliefs:
* There is a defined set of values,
principles, structures, attitudes and
practices inherent in a culturally
competent system of care;
* Cultural competence at both the
organizational and individual levels
is an ongoing developmental
process; and
* Cultural competence must be
systematically incorporated at
every level of an organization,
including the policy making,
administrative, practice and
consumer/family levels.
Avoid Stereotyping
While there are many similarities
among people from the same
cultural background we also need
to be aware of the differences and
variabilities that exist within a
cultural group. In other words,
what may be true for most or some
individuals from a particular region
or culture may not be true for all
the people of that group. Diversity
exists within all groups of people.
This knowledge will lessen the
possible creation or reinforcement
of a cultural stereotype.
All people have unique personal
histories, belief systems, andcommunication styles. Ones
development is impacted by accul-
turation (merging of cultures that
occurs through prolonged contact)
and assimilation (responding to
new situations in conformity). Your
agency may have clients who have
recently immigrated to the United
States and others who have been
here and still identify with their
culture of origin.
Some other questions that contrib-
ute to differences within groups
include:
* People from rural areas may be
living a more traditional lifestyle
than people who emigrate to the
United States from urban areas.
* Economic status and education
can vary greatly among people
from the same country.
* People from the same country
may have migrated to the United
States for very different reasons,
including seeking economic
opportunities, escaping religious or
ethnic persecution, fleeing civil
strife, or joining relatives in
America.
* There are important intra-region
and intra-group variations among
people from the same country, and
cultural variations may be marked
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NFATTC ADDICTION MESSENGER NOVEMBER 2002
Source:
Levin, et al (2000). Appendix: Useful Clinical
Interviewing Mnemonics. Patient Care Specia
Issue, Caring for Diverse Populations: Breaking
Down Barriers
The Providers Guide to Quality & Culture (2000).
Avoi di ng St ero ty pes . Retrieved 10/21/02 from
World Wide Web:
http://erc.msh.org/
National Center for Cultural Competence (2000).
Rational for Cultural Competence in Primary
Health Care. Retrieved10/18/02 from
World Wide Web:
www.georgetown.edu/research/
3PAGE
Cultural Competence:
Counselor Approaches
Next Issue:
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Name:_______________________________________________________________________________________
E-Mail Address:(Please print)____________________________________________________________________
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Phone: ______________________________________________________________________________________
between generations.
Traditional Healing IssuesYour agency may have some
clients who choose to use familiar
folk or traditional cultural treatment
practices in conjunction with your
organizations treatment strategy.
It is important to show tolerance of
and respect for this issue to fully
understand the client and provide
appropriate treatment.
Discussing client beliefs about the
possible causes of an illness and
the remedies tried previously can
be helpful in developing a treat-
ment plan. It is also important to
ask whether the strategy developed
to assist the client conflicts in some
way with personal beliefs and
traditional practices.
The mnemonic framework ETH-
NIC created by Levin, et al
(2000) is a tool that can be used by
care providers who work with
clients who use folk or traditional
practices to provide culturally
competent care. A summary of
questions and issues within the
framework include:
Explanation:
What do you think may be the
reason you have this problem?
What do friends, family, and others
say about your symptoms? Do
you know anyone else who has
had or who now has this kind of
problem? Have you heard about/
read about/seen it on TV/radio/
newspaper? If clients cannot offer
an explanation ask what most
concerns them about their problem.
Treatment:
What kinds of medicines, home
remedies, or other treatments have
you tried for this illness? Is there
anything you eat, drink, or do (oravoid) on a regular basis to stay
healthy? Tell me about it. What
kind of treatment are you seeking
from me?
Healers:Have you sought any advice from
alternative or folk healers, friends,
or other people who are not
doctors on help with your prob-
lems? Tell me about it.
Negotiate:Try to find options that will be
mutually acceptable to you and the
client that incorporate the clients
beliefs, rather than contradicting
them.
Intervention:Determine an intervention with
your client that may incorporate
alternative treatments, spirituality,
traditional healers, science-based
alternatives and other cultural
practices.
Collaboration:Collaborate with the client, family
members, other health care team
members, healers, and community
resources.
The standard for addiction treat-
ment should be inclusive of these
cultural considerations. When they
are seen as an essential part of
treatment planning, only then do
we begin to truly individualize care.
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DECEMBER 2002 VOLUME 5, ISSUE 12 PLEASE COPY OR POST
Ideas for Treatment Improvement
Cultural Competence: Counselor Approaches
Northwest Frontier
Addiction Technology
Transfer Center
3414 Cherry Ave NE, Suite 100Salem OR 97303
Phone: (503) 373-1322
FAX: (503) 373-7348
A project of
Oregon Health &Science University
Steve Gallon, Ph.D.,Project Director
Mary Ann e Bryan, [email protected]
Be sure to check out
our web page at:
http://www.nfattc.com
Unifying science,
education and
services to
transform lives
Recogni ze dif ferences; but bui ld
on simi lari ties...
Josepha Campinha-Bacote, Ph.D.
This final article in our cultural compe-
tency series will provide information
on working with clients from several
cultural backgrounds. General concerns, strat-
egies, challenges, and suggestions for devel-
oping an effective therapeutic relationship will
be addressed. While numerous cultural groups
are represented in our society, this issue fo-
cuses on four of the largest: African Ameri-
cans, American Indian/Alaskan Natives, His-
panic Americans, and Asian American/PacificIslanders. Hopefully, the ideas that appear in
the following paragraphs will inspire creative
and culturally sensitive approaches to treat-
ment planning and delivery.
It is important to keep in mind that diversity
exists within all groups of people. What may
be true for most of the individuals from a par-
ticular cultural group will probably not be ac-
curate for all. Approaching each person as
unique will facilitate your own flexibility and
creativity, and will help you develop a treat-
ment plan that is truly sensitive to the indi-vidual needs of the client.
Cultural Issues in Substance Abuse Treat-
ment (Center for Substance Abuse Treatment
, 1999) was used as a major resource for the
following information. Due to space limita-
tions, the discussion is brief and meant to
stimulate your thinking. For more detailed in-
formation you may order a copy from the Na-
tional Clearinghouse for Alcohol and Drug
Information (NCADI) at (800) 729-6686.
African AmericanThe vast majority of African Americans do not
engage in substance abuse. For those who do,
the patterns vary by age with many tending not
to begin use until after age 21. Initially mari-
juana is one of the most commonly used sub-stances. There appears to be a tendency to
progress from marijuana to heroin.
Health and Social I ssuesAfrican Americans have higher rates of alco-
hol related medical problems than their white
counterparts even though whites have a higher
rate of alcohol use and abuse. HIV infection
is the fourth leading cause of death in African
Americans. HIV/AIDS disproportionately af-
fect African Americans in general and espec-
ially injection drug users. Social repercus-
sions are serious with an estimated half ofAfrican American men in prison serving drug-
related sentences.
Tr eatment ConcernsIssues of trust are the core to service delivery
problems. If a non-African American counse-
lor does not possess a cultural knowledge base,
negative attributions and stereotypes may be
perceived and/or influence the interactions
with clients. For example, many women who
are heads of households have been categorized
as dysfunctional. Such families often prac-
tice a communal form of child rearing. Ex-
tended families are often referred to as a kin-
ship network. The African proverb, It takes a
whole village to raise a child reflects this tra-
dition.
Stereotyping and institutional racism have pro-
found effects on treatm ent access and comple-
tion. Negative experiences with welfare and
social system s have caused m any of these
fam ilies and individuals to be hesitant in pro-
viding personal inform ation. Questions m ay
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NFATTC ADDICTION MESSENGER DECEMBER 20022PAGE
Cultural Competency Websites
DHHS Initiative to Eliminate Racial and Ethnic Disparities in Health
http:www.raceandhealth.hhs.gov
ETHNOMED
http:www.hslib.washington.edu/clinical/ethnomed/index.html
DIVERSITYRX
http:www.diversityrx.org
Cross Cultural Health Care
http:www.xculture.org
Transcultural Care Associates
http:www.transculturalcare.net
National Center for Cultural Competence
http:www.georgetown.edu/research/gucdc
be viewed as prying if an attempt at
building trust with your client has not
been established. Church affiliation
can be a valuable resource to the cli-
ent. Participation in church activities
can improve a persons recovery and
decrease the chance of relapse.
Some treatment programs develop an
Afrocentric approach, which combines
best practices with an African value
system. Such programs emphasize
oneness of spirit between people and
nature. African proverbs can be used
to enhance treatment through increas-
ing insight and broadening perspectives
and thinking styles. Examples of prov-
erbs are:
The ruin of a nation begins in the
homes of its people (Ashanti)
He who conceals his disease cannot
expect to be cured (Ethiopia)
Even an ant may harm an elephant
(Zululand)
American Indian/AlaskanNativeWith over 400 American Indian tribes,
it is important that they not be placed
into a large melting pot. Each has its
own beliefs, ceremonies, and tradi-tions. Alcohol is the drug most fre-
quently used by American Indians.
They tend to begin using alcohol and
illicit drugs at an earlier age than other
cultural groups. Youth frequently
abuse inhalants.
Health and Social I ssues
The negative health and social conse-
quences that American Indians suffer
because of substance abuse are both
quantitatively and qualitatively higher
than other cultural groups. Health
problems include: heart disease, can-
cer, diabetes, injuries and death. More
die from suicide, homicide and alco-
hol-related injuries than any other
group. Women tend to die at higher
rates due to alcohol-involved causes
than women in other cultural groups.
Treatment Concerns
Using culturally sensitive approaches
that incorporate and reinforce tradi-
tional lifestyles increases retention
rates among Alaskan Natives, for whom
binge drinking is a common pattern.
The main barrier affecting treatment is
the lack of social services. Clients liv-
ing in remote areas often resist leav-
ing their communities to seek treat-
ment. Confrontational methods (even
direct eye contact) with this group are
both ineffective and potentially dam-
aging. Situational role modeling and
practice have been found to be useful
and effective relapse prevention tech-
niques.
The use of counseling, psychotherapy
and referral to 12-Step programs, while
effective in the mainstream, may not
appeal to American Indian clients who
often take a long time to disclose per-
sonal information about their lives.
Being aware of historic issues sur-
rounding trust is important while es-
tablishing a therapeutic relationship
with the client. It is important to use a
holistic approach that integrates the useof traditional ceremonies, beliefs, val-
ues and practices in treatment. A cul-
turally competent treatment plan would
include contact with immediate and ex-
tended family members and collabo-
ration with and referral to community
organizations. Traditional practices
that can be used in treatment for
American Indians include:
Talking Circle
The Talking Circle or Talking Stick is a
group activity in which group membersare seated in a circle. The group leader
introduces the Talking Stick and passes
it around the circle. As each member
receives the stick they have the oppor-
tunity to speak freely without fear of
rejection or interruption.
Sweat L odge
The Sweat Lodge is a small dome-
shaped structure with heated rocks in
the center and participants sitting in a
circle around the edge of the lodge.
Water is poured over the rocks to cre-ate steam and prayers are said. The pur-
pose of the Sweat Lodge is to bring par-
ticipants closer to the Creator.
The Good Way
The Good Way promotes spiritual heal-
ing through using traditional culture in
interpreting the 12-Step program. An
example would be - Step 2: I believe
that a greater spirit can help me to re-
gain my responsibilities and model the
life of my forefathers (ancestors).
Hispanic AmericansHispanics tend to use cocaine at higher
rates than African Americans and
Whites. With regard to gender differ-
ences, Hispanic women have lower
substance abuse rates than their male
counterparts. Acculturation may play
a role in this because the longer women
have been in the U.S. culture the more
their use patterns mirror the patterns
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NFATTC ADDICTION MESSENGER DECEMBER 2002
Sources:
3PAGE
Treatment Engagement
Issues
Next I ssue:
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Center for Substance Abuse Treatment(1999). Cul tur al I ssues in Substance
Abuse Tr eatment. Rockville, Maryland
of women in the general population.
Health and Social I ssuesHispanic Americans have a higher per-
centage of AIDS cases related to in-
jection drug use than the general popu-
lation. Tuberculosis in this group of-
ten parallels injection drug use and HIV
infection in the community.
Tr eatment ConcernsHispanic clients will benefit from
treatment programs that address the
following:
* Language, socioeconomic, cultural
and geographic barriers,
* Immigration status (legal versus
illegal),
* Level of acculturation, and
* Service integration.
Underutilization of treatment pro-
grams by Hispanics can also be linked
to lack of bilingual or bicultural staff.
The Hispanic culture values an empha-
sis on respect and the development of
trust in relationships. Confrontational
approaches used in some programs are
degrading to Hispanic clients and are
destructive to their self-esteem. Treat-ment that focuses on a holistic ap-
proach which integrates traditional val-
ues and beliefs and attends to the de-
velopment of a continuing care plan
that reintegrates the client back into
their community will be beneficial to
tend to have a lower prevalence of sub-
stance abuse than other cultural groups.
For those who do use, abuse patterns
and the drug of choice vary across sub-groups. A clients personal migratory
experience and level of acculturation
can add a unique dimension when con-
sidering their substance abuse history
and appropriate treatment plan.
Health and Social I ssuesSubstance abuse problems are on the
rise with Asian Americans and Pacific
Islanders. The relationship between
substance abuse and crime has been
consistently strong as with other cul-
tural groups. It has been noted that ad-aptation to Western culture has
changed the once hierarchical family
structure, family member interdepen-
dence and self-identity of this groups
youth. This may be a factor in sub-
stance abuse predisposition for them.
Treatment ConcernsThe diversity of Asian Americans and
Pacific Islanders has made providing
culturally competent services to this
group a complex issue. The acknow-
ledgement of a substance abuse prob-lem often leads to a considerable loss
of face and feelings of shame for both
the client and their family. Substance
abuse behaviors may be under reported.
Treatment interventions that exclude or
separate the client from their family
may be resisted. Strategies that appear
to decrease powerful family relation-
ships or that blame the parent will not
be advantageous to treatment. Seek-
ing assistance from a treatment pro-
gram is usually viewed as a last resort
by the family and goes outside of nor-
mal acceptable parameters of a culture
that prefers to handle problems withinthe family.
It is important for treatment providers
to be aware of multiple losses, stress-
related issues and adaptation difficul-
ties for many members of all these
cultural groups. Using interventions
such as psycho-education, role-mod-
eling and practice, and development of
coping skills can be productive strate-
gies that demonstrate respect and an ap-
preciation for cultural differences.
Maintaining an awareness of cultureand developing appropriate treatment
approaches are never ending challenges
for us and can be consistent sources
of satisfaction for both the provider and
the client.
the therapeutic relationship.
Asian American/Pacific
IslandersAsian Americans and Pacific Islanders
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Post-TestSeries 8
Cir cle the corr ect answer for each question
#1
A set of congruent behaviors, attitudes and policies that
enable an agency to work effectively in cross-cultural
situations defines:a. Cultural awareness
b. Cultural competence
c. Cultural knowledge
d. Cultural sensitivity
e. None of the above
#2
A definition of ethnicity would include the way in which
groups of people retain and practice customs, language, and
social views of their group.
True False
#3
Characteristics of providing culturally responsive services
would include:
a. sensitivity to cultural nuances of the client population.
b. having staff that is representative of the population.
c. providing services that dont reflect cultural values.
d. none of the above
e. a and b
#4
Cultural competence:
a. does not influence the development of a treatment plan.
b. does not facilitate the acccuracy of a diagnosisc. allows the provider to obtain more specific and complete
information
d. b and c
e. all of the above
#5
Cultural competence:
a. improves the overall communication and clinical interac-
tions between client and provider.
b. leads to improved diagnosis and treatment plans.
c. does not lead to greater client compliance.
d. a and b
e. b and c
#6
Josepha Campinha-Bacote describes a new model of
cultural competence that includes only the following:
cultural awareness, cultural sensitivity, and cultural skills. True False
#7
In Ruth G. Deans article, The Myth of Cross-Cultural
Competence, she suggests :
a. maintaining an awareness of ones lack of cultural
competence is a goal.
b. that people dont have cultural bggage.
c. that it is difficult to become competent at something
(culture) that is continually changing.
d. a and b
e. a and c
#8
Josepha Campinha-Bacote notes that the pivotal construct of
cultural competence that provides the energy source and
foundation for the journey towards cultural competence
comes from:
a. cultural encounters
b. cultural desire
c. cultural knowledge
d. a and b
e. none of the above
#9
A culturally competent agency should implement culturalcompetence at various levels such as:
a. agency attitudes
b. agency practices
c. agency policies and procedures
d. a and b
e. all of the above
#10
Is cultural competency a goal of your agency?
True False
FAX: (503) 373-7348
You can still register for continuing education hours forSer ies 1, 2, 3, 4, 5, 6 or 7
Contact Mary Anne Br yan at (503) 373-1322 ext. 224
Mail or FAX your completed test to NFATTC
Northwest Frontier ATTC, 3414 Cherry Ave. NE, Suite 100, Salem, OR 97303
-
8/14/2019 AM v5 Series 4
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We are interestted in your reactions to the information provided in Series 8of the Addiction
Messenger. As part of your 2 continuing education hours we request that you write a short
response, approximately100 words, regarding Series 8. The following list gives you some sugges-
tions but should not limit your response.
What was your reaction to the concepts presented in Series 8?
How did you react to the amount of information provided?
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What information would have liked more detailabout?
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