Communication%20Across%20Cultures

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Communication Across Cultures

• Marian H. Jarrett, Ed.D.
• Lorelei Emma, M.A.
• George Washington University
• 6th Annual Infant and Toddler Connection of
  Virginia Early Intervention Conference 2008

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• Across cultures, people may differ in what they
  believe and understand about life and death, what
  they feel, what elicits those feelings, the
  perceived implications of those feelings, the
  ways they express those feelings, the
  appropriateness of certain feelings, and the
  techniques for dealing with feelings that cannot
  be directly expressedTo help effectively, we
  must overcome our presuppositions and struggle to
  understand people on their own terms. (Irish,
  Lundquist, Nelson, 1993, p. 18)

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Agenda

• Introductions
• Part 1 Grieving Process
• Part 2 Communication
• Part 3 Case Scenario Discussion
• Part 4 Questions and Group Discussion

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Children and Families and Culture

• Family adjustment seen in context of family
  systems and ecological model

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Grief is a normal response to an abnormal
situation

• Grieve the loss of the expected child
• Pregnancy images of the imagined child
• Process of grieving and adaptation is complex and
  confusing for family
• Grief does not signal non-acceptance or devaluing
  of the family member

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Grief A Complex, Personal Experience

• No typical time some suggest 1-3 years
• Varies greatly from individual to individual
• How person copes depends on previous coping
  behaviors
• Grief for a disability may become more intense
  during periods of transition

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Secondary Losses Compound Initial Grief Reactions

• Families experience stress as secondary losses
  when needs are not met
• Secondary losses may challenge a familys ability
  to manage grief
• Services should be family-centered,
  relationship-based, and culturally competent
• Consider the impact of respite services, in-home
  medical support and therapy, financial
  assistance, and family support for this
  particular family

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Predominant Phases of Grief

• Traumatic Stress or Shock
• Assimilation
• Acknowledgment and Integration
• Phases recycle and blend into one another
• Certain feelings predominate in each phase

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Phase 1 Traumatic Stress

• Period immediately following diagnosis
• Numbness, shock, disturbed sleep, panic, and
  despair
• Families
• Make major decisions about treatment and services
• Report do not hear what doctors and service
  providers say
• Try to understand meaning of diagnosis
• May experience relief with diagnosis

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Feelings Behaviors in Initial Phase

• Gather as much information as possible
• Express anger at doctors and diagnosis
• Tearful and withdrawn
• Preoccupation with imagined child
• Panic and helplessness
• Focused on immediate needs
• Frightening for siblings

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Phase 2 Assimilation

• Confusion begins to dissipate
• Sharper realization of nature and extent of
  disability
• Family members show highly idiosyncratic,
  changing responses
• Heavily influenced by personality and contextual
  factors
• Period when families experience their most
  intense reactions to loss of hoped-for child

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Feelings in Assimilation Phase

• Hope
• Anxiety and restlessness
• Depression and anxiety
• Guilt
• Anger
• Social Isolation

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Phase 3 Acknowledgment and Integration

• Greater understanding and acknowledgment of
  disability
• Greater integration of child with a disability
  into the family
• Periods of distress are briefer, less intense
• Parents still report having a bad day

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Behaviors and Feelings in Integration Phase

• With help, family members can
• acknowledge they are feeling better
• distinguish grief-related stress from other
  stress
• Acknowledge there is no getting back to normal.
  Families are forever changed.
• Begin to see self as a parent, not just a parent
  of a child with a disability
• Embed learning into daily routines

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Cultural Competence in Supporting Families Who
Are Grieving

• Definition
• A set of values, behaviors, attitudes, and
  practices within a system, organization, program
  or among individuals and which enables them to
  work effectively cross culturally.
• Ability to honor and respect the beliefs,
  language, interpersonal styles and behaviors of
  individuals and families receiving services, as
  well as staff who are providing such services.
• (Division of Services for Children with Special
  Health Care Needs, 2005)

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Cultural Competence as a Process

• Cultural competence is not an end-state, but a
  process
• Encompasses not only cultural knowledge on the
  part of the service provider, but also
  constructive attitudes and attention to the total
  context of the familys situation.

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Barriers to Culturally Competent Care

• Institutional Barriers
• Lack of diversity in health cares leadership and
  workforce
• Systems of care poorly designed to meet the needs
  of diverse patient populations
• Poor communication between providers and patients
  of different racial, ethnic, or cultural
  backgrounds
• Personal Barriers
• Betancourt, Green, Carrillo, 2003

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Development of Cultural Competence

• 3 Step Process (Iterative, No endpoint)
• 1. Clarification of the service providers own
  values, attitudes and assumptions
• 2. Knowledge of commonly held cultural beliefs
  and the culturally normative interactive styles
  of specific cultural groups
• 3. Skills that enable the individual to engage in
  successful interactions
• AAP, 1999 Lynch Hanson, 2004

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Self-Awareness Activity

• Understanding Our Own Place on the Continua
• InterdependenceIndependence
• Kinship (extended family)Nuclear family
• High contextLow context
• Religious orientationSecular Orientation
• Authoritarian child-rearingPermissive
  childrearing
• Greater respect for older family membersGreater
  emphasis on youth
• Oriented to the situation.Oriented towards time

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Disability, Death, and Culture

• When individuals are confronted with the fear and
  senselessness of disability, illness, and death,
  culture can
• Provide meaning for those who are grieving
  through its beliefs about life after death
• Define care of the body after death and burial or
  cremation practices
• Describe roles for grieving family members and
  for the community which surrounds them
• Influence how grief is expressed
• Affect how grieving families interact and
  communicate with caregivers
• Impact how families approach decisions about
  interventions, treatment, and end-of-life
  decisions

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Beliefs and Values Influence Grieving Process

• Beliefs about
• disability and infant death
• medical care
• Values of
• Family
• Religion
• Education
• Age

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Influence of Other Factors

• Age
• Gender
• SES
• Education
• Length of time in the US
• Level of acculturation

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Communication

• 10.5 million U.S. residents speak little or no
  English
• Different languages difficulty communicating
• Even with same language, language of disability
  and grief are always difficult.
• (U.S. Census Bureau, 2001)

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Effective Communication

• Medium through which families and providers
  negotiate the process of caring for an infant or
  young child with disabilities or a
  life-threatening illness
• Basic tool used to establish and maintain
  relationships with families
• Essential to family-centered and
  culturally-sensitive care

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Fostering Shared Meaning and Mutual Understanding

• Shows interest and encourages parent to continue
• Uses open-ended questions to help parents
  describe their perceptions and feelings
• Uses focused questions to gain specific
  information
• Paraphrases the content of parent communication
• Validates parents feelings
• Remains nonjudgmental

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Examining Our Own Communication

• Unconsciously learned ways to think, feel, and
  act according to what our culture considers
  appropriate
• Often unable to set aside our own cultural values
  and listen to the family
• May unwittingly violate cultural assumptions
  about the parents role, cause of disability, or
  intervention options

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Examining Your Own Cultural Values, Beliefs, and
Practices

• Complete the Values Clarification Exercise in the
  back of your packet.
• Read each statement, rate it, and move to the
  next statement.
• There are no right or wrong answers.

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Values Clarification Exercise

• Review your responses.
• Examine each statement by asking
• Why do I feel this way?
• How might this affect my interactions with
  children and families?

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Social Organization

• Who are the members of the family system?
• Who is the spokesperson?
• Who should be included in discussions?
• Is full disclosure acceptable?
• Who makes decisions in the family?

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Showing Respect

• Can be based on age, gender, social position,
  education, economic status and authority
• Formality of communication shows respect
• Distinct lines drawn between members of society
  in some cultures can impeded open communication

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Communication Style

• Low context culture European American
• Direct, precise, logical verbal communication
• High context culture Hispanic, Asian, African
  American, Native American
• More informal
• Rely more on situational cues
• Non-confrontational responses
• Well-established hierarchies
• Physical cues and relationships are easily
  perceived

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High Context Cultures

• May be inappropriate to ask informally about
  family and disability or medical issues
• Coming directly to decision-making may seem rude
  or insensitive
• Direct confrontation and questioning may cause
  discomfort and even shame

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Revert to What is Comfortable

• Low context communicators may
• Talk less
• Speak faster
• Raise the volume of their voice
• High context communicators may
• Say less
• Make less eye contact
• Withdraw from the interaction

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Providers Must Adapt Their Communication Style

• Slow down and talk less
• Look for meaning in physical gestures
• Focus on the context of the family and the
  interaction
• Be aware of hierarchical differences within
  families and between the family and the provider

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Cultural Blind Spot Syndrome

• Low socioeconomic status
• Inexperience with Western health care and
  education system
• Lack of or limited formal education
• Emigration from a rural area
• Little knowledge of English
• Recent immigration to the U.S. at an older age
• Segregation in an ethnic subculture
• (Buchwald, et al., 1994)

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L-E-A-R-N

• Listen with sympathy and understanding to the
  familys perception of the problem
• Explain your perceptions of the problem
• Acknowledge and discuss the differences and
  similarities
• Recommend intervention
• Negotiate agreement

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Guidelines for Cross-Cultural Nonverbal
Communication

• Eye contact can be sign of disrespect,
  hostility or rudeness
• Observe family members and members of cultural
  groups
• Body language and facial expressions may be
  interpreted differently
• Ask for clarification of concerns, check for
  questions, or reword information being presented
• Silence some comfortable with long silences
  some speak immediately
• Listen to conversations between members of the
  same culture to learn the use of pauses and
  interruptions
• Silence can have many meanings difficult to
  assess

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Guidelines contd

• Distance preferred distance is 2-3 feet in U.S.
• Give family members a choice of where to sit
• Stand with room for parents to move closer or
  farther away
• Touch norms for how and when to touch
• Touching not common for South Asians and West
  Indians
• In some Latino cultures, touching conveys lack of
  respect, especially older people

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Recommendations to Facilitate Communication

• Encourage open dialogue by asking about family
  relationships, values and beliefs.
• Informally determine fluency of family by asking
  open-ended question.
• Encourage family to ask questions.
• Ask family questions to check understanding.
• Summarize what the parent says.
• Do not discourage family from talking among
  themselves in their own language.

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Recommendations to Facilitate Communication

• Work with cultural mediators.
• Learn and use words and forms of greeting.
• Provide information in different forms oral,
  written, pictorial, demonstration.
• Rely on the interpreter, observations, instincts,
  and knowledge to know when to proceed and when to
  wait.

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Working with an Interpreter

• Use trained interpreters for important meetings
  with the family.
• Allow additional time to determine cultural
  values, beliefs and perspectives.
• Reinforce verbal interaction with material
  written in familys language.
• Provide an interpreter when requested by the
  family even if they speak some English.

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Case Scenario

• Overview of case
• Small group discussion
• Sharing out with whole group

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References

• Buchwald, D. Panagiota, V.C., Francesca, G.,
  Hardt, E.J., Johnson, T.M., Muecke, M.A.
  Putsch, R.W. (1994). Caring for patients in a
  multicultural society. Patient Care, June 15,
  1994, 105-123.
• Lynch, E.W. Hanson, M.J. (2004). Developing
  cross-cultural competence A guide for working
  with children and families. (3rd Ed.) Baltimore
  Paul H. Brookes Publishing Co., Inc.
• Montgomery, W. (2001). Creating culturally
  responsive, inclusive classrooms. Teaching
  Exceptional Children, 33(4), pp. 4-9.
• U.S. Census Bureau. (2002). Number of
  foreign-born up 57 percent since 1990, according
  to Census 2000. Retrieved July 12, 2004, from
  http//www.census.gov/Press-Release/www/2002/cb02c
  n117.htm

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Contact Information

• Please feel free to contact either presenter with
  questions, comments, request for further
  information/resources, or to provide them with
  additional information/resources
• Marian Jarrett mjarrett_at_gwu.edu
• Lorelei Emma loreemma_at_gwu.edu