cultural competence and risk communication presented by darci l. graves, ma, ma university of...
TRANSCRIPT
Cultural Competence and Risk Communication
Presented by Darci L. Graves, MA, MA
University of Maryland-Baltimore County
Today’s Objectives
• Explain how preparedness messages are perceived across various cultures
• Discuss the significance of delivering culturally appropriate preparedness messages
• Describe strategies for culturally competent communications during a public health emergency
Cultural Competence & The Front Page
• Terrorism/Violence– 9/11– Iraq – Virginia Tech
• Natural Disasters – Tsunami – Katrina
• Celebrity “Missteps” – Michael Richards – Isaiah Washington – Don Imus– Richard Gere
• Not to mention– Health Insurance– Immigration
• People prepare, respond, and recover from disaster within the context of their culture.
• Culture offers a protective system that is both comforting and reassuring.
• It defines appropriate behavior and furnishes a support system, and identifies a shared vision for recovery.
• Despite the strengths of culture, responses from some groups may make them more vulnerable than others.
Every encounter is a cross-cultural
encounter.
- Robert C. Like, MD, MS
Defining “Culture”
Culture refers to integrated patterns of
human behavior that include the language,
thoughts, communications, actions,
customs, beliefs, values, and institutions of
racial, ethnic, religious, or social groups. » [Based on Cross, T., Bazron, B., Dennis K., & Isaacs, M.,
(1998). Towards A Culturally Competent System of Care Volume I. Washington, D.C.: Georgetown University Child Development Center, CASSP Technical Assistance Center).
Aspects of Culture that are also Health Determinants
Language Urban/Rural
Ability/Disability
Socio-Economic Status
GenderSexual Orientation
Health Status
Religion/Spirituality
Occupation
Race/Ethnicity
Cultural Competence
A historic progression in the U.S.:
Cultural awareness…
Then cultural sensitivity…
And now cultural competence.
Cultural Competence
Cultural Competence is a set of
congruent behaviors, attitudes, and
policies that come together in a
system, agency, or among
professionals that enables effective
work in cross-cultural situations.» [1] HHS Office of Minority Health Culturally and Linguistically
Appropriate Services Standards, at www.omhrc.gov/assets/pdf/checked/executive.pdf.
Need for Cultural Competence• Respond to current and projected demographic changes in
the United States
• Reduction of long-standing disparities in the physical and
mental health - status of people from differing racial,
ethnic and cultural backgrounds
• Improvement of the quality of services and primary care
outcomes
• Compliance with legislative, regulatory and accreditation
mandates
• Creation of a competitive edge in the market place
• Decrease in the likelihood of liability/malpractice claimsNational Center for Cultural Competence. 2003.
Health Disparities
The Institute of Medicine, in its publication, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” determined that the “development and implementation of training programs for health care providers [around topics of cultural competence] offer promise as a key intervention strategy in reducing healthcare disparities”. [1]
[1] Smedley, Stith and Nelson. 2003.
1985
2000
1964
1946
CLAS
Standards
Executive Order 13166
Establishment of federal Office of Minority Health
Civil Rights Act – Title
VI
Hill-Burton Act
Federal Legislation & Policies
1990 Healthy People 2000Healthy People 2010
2001
Graves, D., Like, R., Hohensee, A. and Kelly, N. 2007.
Cultural Competence Legislation
• The CLAS standards are primarily directed at health care
organizations; however, individual providers are also encouraged to
use the standards to make their practices more culturally and
linguistically accessible. The principles and activities of culturally
and linguistically appropriate services should be integrated
throughout an organization and undertaken in partnership with the
communities being served.
• The 14 standards are organized by themes: Culturally Competent
Care (Standards 1-3), Language Access Services (Standards 4-7), and
Organizational Supports for Cultural Competence (Standards 8-14).
Within this framework, there are three types of standards of varying
stringency: mandates, guidelines, and recommendations as follows:– CLAS mandates are current Federal requirements for all
recipients of Federal funds (Standards 4, 5, 6, and 7). – CLAS guidelines are activities recommended by OMH for adoption
as mandates by Federal, State, and national accrediting agencies (Standards 1, 2, 3, 8, 9, 10, 11, 12, and 13).
– CLAS recommendations are suggested by OMH for voluntary adoption by health care organizations (Standard 14).
National Standards on Culturally and Linguistically Appropriate Services (CLAS)
www.omhrc.gov
Goal for Today’s Conference
The goal of the conference is to provide information and education on effective crisis communication principles using real-life examples as a guide.
What Is Risk Communication?
Risk communication has many definitions. Two basic ones are:
1) “An interactive process of exchange of information and opinion among individuals, groups and institutions. It involves…messages about the nature of risk and other messages not strictly about risk…that expresses concerns, opinions or reactions to risk messages…..”
2) "The exchange of information among interested parties about the nature, magnitude, significance or control of risk .”
http://www.njcphp.org/rc/index.cfm
… there many goals of risk communication
"Enable individuals to "make informed… decisions for themselves and their community."
"Dispel myths…reduce fears, and, in times of crisis, to alert the pubic and provide directions for urgent action."
http://www.njcphp.org/rc/index.cfm
Anticipate Community Needs Through OUTREACH
• O - Outline Goals• U - Understand Audience Beliefs &
Bias • T - Training & Team Building • R - Resource Inventory • E - Engage Community• A - Adopt & Adapt Plan• C - Communicate • H - Hindsight
Outline Goals
• What is the threat you are trying to prevent?
• What is the recommended response to avert the threat?
• Who is the target audience?
Understand Audience Beliefs and Bias• Gay/lesbian/bisexual/transgender• Those in poverty• Racial/ethnic minorities• Religious/Spiritual minorities• Persons with disabilities• Patients with HIV/AIDS• Children• Older adults• Cultural minorities (e.g., Amish, Appalachian)• Military culture• Migrant workers/homeless/displaced persons• Persons with mental illness
Understand Audience Beliefs and Bias
Language Urban/Rural
Ability/Disability
Socio-Economic Status
GenderSexual Orientation
Health Status
Religion/Spirituality
Occupation
Race/Ethnicity
Understand Audience Beliefs and Bias
• Know Your Organization’s Reputation in the Community– Recognize that some populations may
have a distrust or fear of government and health institutions
– Refugees and immigrant populations– Tuskegee Syphilis Study (1932-1972)
– Conduct research to better understand your organization’s reputation
– Surveys and focus groups– Meet with local leaders of community-based
organizations– Request feedback and input on how to improve or
change reputation
Understand Audience Beliefs and Bias
• trust and credibility
Center for Risk Communication
Understand Audience Beliefs and Bias
• Who are the most vulnerable persons in the community? Where do they live?
• What is the range of family composition (i.e., single-parent households)?
• What cultural groups (ethnic, racial, and religious) live in the community?
• Where do they live, and what are their special needs?
• What are their values, beliefs, and primary languages?
• Who are the cultural brokers in the community?
Understand Audience Beliefs and Bias
• Does the community have any special economic considerations that might affect people’s vulnerability to disaster?
• Are there recognizable socioeconomic groups with special needs?
• How many live in rental property? How many own their own homes?
Training and Team Building
• Training is perhaps the most important step. Once staff have taken a training program, their awareness is heightened, and they will be better equipped to design plans & programs that take into account the needs of culturally diverse & Limited English Proficient populations.
Training and Team Building
• Training – have staff members received cultural competence training?
• “Champions” – are there any individuals who are committed to this cause, and if so, can they assist with the emergency preparedness plan?
• Form an Internal Team - Cultural Competence is an ongoing process and must be revisited through continual training and discussion.
Resource Inventory
• Representation – are any of your staff
members of diverse communities who can
serve as liaisons/advisors?
• Knowledge – Do existing staff members have
a good understanding of the ethnic and
linguistic composition of the community?
• Partners – Can vendors/suppliers support the
plan?
Resource Inventory
• What services do you already utilize?
• What partners do you already have?
• What experts do you have access to?
Resource Inventory
• Language Support– Translation Services (are written
materials available in other languages?)
– Interpreting Services (can we communicate with members of the community via telephone and in person?)
– Bilingual Staff (how do I evaluate staff members’ language proficiency?)
Resource Inventory
• Factors to Consider for TRANSLATION (written documents)
– Do we have a partner for translation services?
– If using in-house staff to translate, consider:
– Are these individuals truly qualified (ATA certified)?
– What are the indirect costs of taking this individual
away from other work?
– What about errors and omissions insurance ($71
million lawsuit in Florida)?
– Does my staff have the tools and expertise necessary
for industry standards related to professional
translation (terminology management software,
translation tools, desktop publishing, localization
expertise, etc.)?
Resource Inventory
Questions to Ask for Quality Translation Services
– Does the provider use translation memory tools? This is the industry
standard. All professional providers should offer this as a feature to you. This
results in cost savings due to economies of scale & translation terminology
memory that is leveraged over time.
– Are there any hidden costs? Do not judge only on price per word. Ask for a
clear list of all charges; if certain services are not offered (editing,
proofreading, desktop publishing), where will these services be obtained?
– Does the provider offer culturally appropriate services? Ensure that your
provider does cultural adaptation - not just simple linguistic transfer.
– Can the provider assist with literacy issues? If you know the average reading
level of your target population, the translation provider should be able to
adapt the reading level.
– Am I protected? The organization should provide qualified and certified
translators only, and should offer comprehensive insurance.
Resource Inventory
• Factors to Consider for INTERPRETING (spoken language needs)
– Do we have a partner for interpreting services?
– What happens if the local area is affected (will the partner
be affected as well?)
– Do we have access to an interpreting service that is
available 24/7?
– Do we have access information readily available?
– Does the partner have a back-up/emergency redundancy
plan?
– Do we have a list of volunteer interpreters/bilingual staff
available for emergencies?
– Do we have a plan in place to notify/activate our back-up
interpreters/volunteers?
Resource Inventory
• Factors to Consider for BILINGUAL STAFF (spoken
language needs)
– Have staff members been tested for language
proficiency?
– Written vs. oral
– Incentive or recognition program for testing
– Is there a roster of individuals with proven
language proficiency?
– Proficiency does not equal interpreting or
translation ability
Engage Community
• What resources and supports would community and cultural/ethnic groups provide during or following a disaster?
• Do the groups hold pre-existing mutual aid agreements with any State or county agencies?
• Who are the key informants/ gatekeepers of the impacted community?
• Has a directory of cultural resource groups, natural helpers, and community informants who have knowledge about diverse groups been developed?
• Are the community partners involved in all phases of disaster preparedness, response, and recovery operations?
Engage Community
• Ensure access to services and information
• Consider teaming with other organizations
• Public safety / education resources / partnerships
• Identify Partners - Places of worship, other Government organizations, FBOs, CBOs, staff/volunteers, etc. Use all of these to share information.
Engage Community
Percent Distribution of NJ Population2004 Census Data New Jersey U.S.
Population, percent change, April 1, 2000 to July 1, 2005
3.6% 5.3%
Population, percent change, 1990 to 2000
8.6% 13.1%
Persons under 5 years old, percent, 2004
6.7% 6.8%
Persons under 18 years old, percent, 2004
24.8% 25.0%
Persons 65 years old and over, percent, 2004
12.9% 12.4%
Female persons, percent, 2004 51.3% 50.8%
http://quickfacts.census.gov/qfd/states/34000.html
Engage CommunityPercent Distribution of NJ Population2004 Census Data New
JerseyU.S.
White Persons 76.9% 80.4%
Black Persons 14.5% 12.8%
American Indian and Alaska Native Persons
0.3% 1.0%
Asian Persons 7.0% 4.2%
Native Hawaiian and Other Pacific Islander
0.1% 0.2%
Persons Reporting Two or More Races
1.2% 1.5%
Persons of Hispanic or Latino Origin 14.9% 14.1%
White Person, not Hispanic 63.8% 67.4%
http://quickfacts.census.gov/qfd/states/34000.html
Engage Community
Most spoken languages in New Jersey:English is spoken by 74.53% of people over 5 years old in New Jersey. Languages other than English are spoken by 25.46%. Speakers of languages other than English are divided up as follows.
http://www.mla.org/cgi-shl/docstudio/docs.pl?map_data_results
Engage Community
% Speakers of Languages Other than English by county
http://www.mla.org/census_compare
Engage Community• Language Total % • English 262,340 80.11% • All languages other than English combined
65,117 19.88% • Spanish 29,170 8.90% • Italian 4,410 1.34% • Polish 3,545 1.08% • Chinese 3,320 1.01% • French 2,325 0.71% • German 2,285 0.69% • French Creole 1,755 0.53% • Korean 1,430 0.43% • Russian 1,410 0.43% • Gujarathi 1,299 0.39% • Arabic 1,279 0.39% • Hindi 1,154 0.35% • Ukrainian 1,015 0.30% • Urdu 985 0.30%
• Tagalog 714 0.21%• Greek 600 0.18% • Japanese 590 0.18% • Kru, Ibo, Yoruba 550 0.16% • Hungarian 505 0.15% • Mandarin 490 0.14% • India 440 0.13% • Tamil 400 0.12% • Telugu 385 0.11% • Hebrew 384 0.11% • Formosan 340 0.10% • Panjabi 325 0.09% • Dutch 295 0.09% • Turkish 275 0.08% • Portuguese 270 0.08% • Total: 327,457
http://www.mla.org/map_data_results&state_id=34&county_id=21&mode=geographic&zip=&place_id=&cty_id=&ll=top&a=&ea=n&order=r
Mercer County
Adopt & Adapt Plan
• What are the Federal, State, and local roles in disaster response?
• How do Federal, State, and local agencies relate to one another?
• Who would lead the response during different phases of a disaster?
• How can mental health services be integrated into the government agencies’ disaster response?
• What mutual aid agreements exist? • Do any subgroups in the community harbor
any historical or political concerns that affect their trust of government?
Adopt & Adapt Plan
• What are the roles of the American Red Cross, interfaith organizations, and other disaster relief organizations?
• What resources do non-government agencies offer, and how can local mental health services be integrated into their efforts?
• What mutual aid agreements exist? • How can mental health providers
collaborate with private disaster relief efforts?
Adopt & Adapt Plan
• Is there support for your plan from all participating parties?– Internal staff– External vendors / suppliers– Organizational partners– Community partners– Public at large
Adopt & Adapt Plan
• Is the emergency preparedness plan appropriate from a cultural and linguistic standpoint?– Communication – make sure that the
communication channels in place are appropriate for reaching all affected populations
– Preparedness – have key messages (e.g. evacuation instructions, maps, emergency preparedness guides, etc.) translated in advance and distribute information to the community through channels
– Input – ask community leaders to provide insight for how to improve upon existing plans
Adopt & Adapt Plan
• Are policies and procedures in place to collect, maintain, and review current and emergent demographic data for any area that might be affected by a disaster?
• How could individuals be identified and reached in a disaster?
Communicate
• In your plan, identify communication channels and means of access, for example:– Will printed copies of the
information/resources be available? If so, at what locations (community centers, places of worship, other frequently visited sites within the community)?
– Will information be available in other media (web, telephone, etc.)? If so, will the access method be linguistically and culturally appropriate?
Communicate
• Is the emergency preparedness plan appropriate from a cultural and linguistic standpoint?– Communication – make sure that the
communication channels in place are appropriate for reaching all affected populations
– Preparedness – have key messages (e.g. evacuation instructions, maps, emergency preparedness guides, etc.) translated in advance and distribute information to the community through channels
– Input – ask community leaders to provide insight for how to improve upon existing plans
Hindsight
• What have we learned from the past?– Katrina– Anthrax– Pandemics
Hindsight
• Does the plan meet the goals?• Was the plan developed with the audience in
mind?• Are all the available resources being utilized?• Are all stakeholders being trained?• Has the community been engaged in
developing the plan?• Has the plan been adopted and adapted as
necessary?• Have past lessons been incorporated?
Considerations for Ongoing Evaluation
• Can there be a task force dedicated to cultural
and linguistic aspects of emergency preparedness
in the state? If so, what other government
entities might support this? (e.g. public safety)
• Can there be work teams within individual
counties and cities that focus on these tasks?
• Will there be ongoing dialogue and sharing of
best practices on this topic? If so, in what venue?
Cultural Competence
• Should be a part of an organization’s overall mission and objectives as a component of all services (not just emergency preparedness).
• Cultural competence will aid in the establishment of trust and rapport which will be key when and if an emergency occurs.
Keys to Implementation
• Journey Mentality• Training• Collaboration • Expert Partners• Research• Internal/External Policy
Review• Methodology• Shared Understanding of
Definition of “SUCCESS”
Graves, D., Like, R., Kelly, N. and Hohensee, A. 2007.
