Cultural Sensitivity in Diverse Communities

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Cultural Sensitivity in Diverse Communities

• Dr. Charles Amrhein
• William Brandshagen
• Dr. James Kiffer
• Dr. Lee Underwood

Smart Responses in Tough Times Achieving Better
Outcomes for People with Mental Illnesses
Involved in the Criminal Justice System July
15-17, 2009
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Competency Motivational Strategies
Understanding Miscues
Lee A. Underwood, Psy.D., Clinical
Director Arizona Department of Juvenile
Corrections
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Class Objectives

• Define terms associated with cultural competency
• Discuss the cultural competency continuum
• Discuss perceptions and how communication miscues
  occur
• Discuss motivational strategies for juveniles
• Identify ways to become more culturally competent

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Definitions

• Lets make sure we are all on the same page by
  defining some words associated withCultural
  Competency

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Related Terms

• Institutionalized Racism
• Also referred to as Structural or Systemic Racism
• A form of racism which is structured into
  political and social institutions
• Occurs when institutions, including corporations,
  governments and universities, discriminate either
  deliberately or indirectly, against certain
  groups of people to limit their rights.
• Reflects the cultural assumptions of the dominant
  group, so that the practices of that group are
  seen as the norm to which other cultural
  practices should conform

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Related Terms

• Institutionalized Racism contd
• More subtle, less visible, and less identifiable
  than individual acts of racism, but no less
  destructive to human life and human dignity.
• The people who manage our institutions may not be
  racists as individuals, but they may well
  discriminate as part of simply carrying out their
  job, often without being aware that their role in
  an institution is contributing to a
  discriminatory outcome.

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Cultural Competence Continuum

• Ignorance Awareness
  Sensitivity Understanding
  Competence

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Ignorance Is

• the state or fact of being ignorant lack of
  knowledge, education, or awareness

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What Ignorance Looks Like
Unaware of biases, prejudices or their impact on
others. Unaware of pain and damage to
others Unaware behavior is offensive. Accept
stereotypes as facts.
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Cultural Awareness
being cognizant, observant, and conscious of
similarities and differences among cultural groups
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What Awareness Looks Like
Aware of biases and prejudices. Aware that their
behavior offends others. But still may behave in
ways that reinforce and reward bigotry.
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Cultural Sensitivity is.

• the ability to adjust ones perceptions,
  behaviors, and practice styles to effectively
  meet the needs of different ethnic or racial
  groups

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What Sensitivity looks like
Aware of biases in selves and others. Work on
their prejudices, reluctant to address
inappropriate behavior of others. Play it safe by
saying nothing. Silent supporters.
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Cultural Understanding is

• understanding the needs and emotions of your own
  culture and the culture of others

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What Understanding looks like
Aware of biases in selves and others. Willing
to take action when they encounter
inappropriate words, behaviors. Respond in way
that is fair to others.
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Cultural Competency is

• a set of skills, knowledge and attitudes, which
  enhance an individuals
• awareness of his or her own assumptions and
  values as well as other prevailing attitudes
  toward culture within the United States
• understanding of and respect for others values,
  beliefs and expectations and
• the ability to adapt his or her interactions to
  be more in touch with others expectations and
  preference.

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What Competency looks like
Constantly aware of any behaviors that seems to
be biased or prejudiced.  Question actions of
others and confronts people about such behaviors.

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Iceberg Metaphor

• Only 10 of an iceberg is visible (conscious)
  whereas the other 90 is beneath the water
  (preconscious and unconscious).
• The Preconscious is allotted approximately 10
  -15 whereas the Unconscious is allotted an
  overwhelming 75-80.

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Perceptions
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Cultural Miscues

• Brief and commonplace daily verbal, behavioral or
  environmental indignities, whether intentional or
  unintentional, that communicate hostile,
  derogatory or negative racial slights and
  insults.
• People are generally unaware that they engage in
  such communication when they interact with
  racial/ethnic minorities.
• A taxonomy (list) of examples was created through
  a review of the literature

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Examples of Cultural Miscues
THE STATEMENT
THE MESSAGE
THE THEME
You are not American. You are a foreigner.
When a person is assumed to be foreign born
Where are you from? Where were you born? You
speak good English.
People of color are generally not as
intelligent. It is unusual for someone of your
race to be so intelligent
You are a credit to your race. You are so
articulate
Assigning intelligence
A white man or woman clutches purse or wallet as
a person of color passes. A store owner following
a customer of color around the store
Criminality /assumption of criminal status
You are a criminal. You are dangerous. You are
going to steal.
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Offensive Statements

• Indian giver
• Thats so gay.
• She welshed on the bet.
• I jewed him down
• Thats so white of you.
• You people . . .
• We got gypped.

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Motivational Strategies

• Motivational Interviewing (Rollinick Miller)
• A directive, client-centered counseling style for
  eliciting behavior change
• Helps clients to explore and resolve ambivalence
• A focused and goal directive approach
• The examination and resolution of ambivalence is
  its central purpose

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Motivational Strategies

• Spirit of Motivational Interviewing
• Motivation to change is elicited from the client,
  and not imposed by the therapist
• Its the clients task, not the counselors, to
  articulate and resolve his or her ambivalence
• Direct persuasion is not an effective method for
  resolving ambivalence
• The counseling style is generally a quiet and
  elliciting one

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Motivational Strategies

• Spirit of Motivational Interviewing
• The counselor is directive in helping the client
  to examine and resolve ambivalence
• Readiness to change is not a client trait, but a
  fluctuating product of interpersonal interaction
• The therapeutic relationship is more like a
  partnership or companionship than
  expert/recipient roles

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Motivational Strategies

• You violate the spirit of Motivational
  Interviewing when you
• Argue that the person has a problem and needs to
  change
• Offer direct advice
• Prescribe solutions to the problem without the
  persons permission or without actively
  encouraging the person to make his or her own
  choices
• Use an authoritative/expert stance leaving the
  client in a passive role

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Motivational Strategies

• You are violating the spirit of Motivational
  Interviewing when you
• Do most of the talking
• Function as a unidirectional information delivery
  system
• Impose a diagnostic label
• Behave in a punitive or coercive manner

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Motivational Strategies

• Transtheoretical Model of Change (Prochaska and
  Diclemente)
• Illustrates the process of change people go
  through
• A sequence of stages through which people
  typically progress as they think about, initiate,
  and maintain new behavior
• Can assist the counselor and program staff with
  identifying ways to support and guide the client
  through the process

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Stages of Change
PERMANENT EXIT
PRE- CONTEMPLATION
Prochaska and DiClementes six stages of
change. Taken from Miller and Rollnick
(1991), Motivational Interviewing, Guilford
Press.
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Putting the Pieces Together

• Culturally competent service providers are
  supportive mentors and coaches who
• Value diversity
• Conduct self-assessments
• Manage the dynamics of differences
• Acquire and incorporates cultural knowledge
• Adapts to diversity and the cultural contexts of
  the individual they serve
• National Center for Cultural Competence

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Putting the Pieces Together

• Culturally competent delivery systems
• Have vision, mission and values that support
  diversity and cultural competency
• Offers on-going training at all points of contact
• Elicit feedback from clients and staff
• National Center for Cultural Competence

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Putting the Pieces Together

• Culturally competent delivery systems
• Have a CQI and program fidelity component
• Have updated policy and procedures that are in
  concert with its vision, mission and values
• Willingly examines disproportionate minority
  confinement at all decision points

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Putting the Pieces Together

• Culturally competent delivery systems have the
  following treatment components
• Screening and assessment
• Classification and reclassification
• Multi-Disciplinary Treatment Team (MDT)
• Treatment and transition planning
• Core and specialty treatment services
• Family support and involvement

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Dr. Charles AmrheinClinical Director, BronxTASC
Mental Health CourtProgram, NY
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Guam and Micronesiaa History of
CulturalDiversity Presented by James Kiffer,
PhDandW. J. Brandy Brandshagen
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Pre-contact Micronesia

• Throughout the islands much of the pre-contact
  information has been lost to time.
• Most of the documentation of pre contact Guam
  and Micronesia was made by Spanish Priests sent
  to convert the indigenous people to Catholicism.
• Islanders had a different sense of privacy and
  ownership.
• This was the cause for much discord between the
  islanders and the Europeans.

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Magellan Lands on Guam 1521

• The people living on Guam called themselves
  Chamorros.
• On one of Magellans ships there was a bloody
  altercation during which a small rowboat was
  taken (borrowed??).
• In return the Spanish burned a village and took
  their boat back.
• Guam and Micronesia then became known as
• Islas De Las Ladrones
• or
• Islands of the Thieves

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The Extended Family

• As is in many traditional societies the
  fundamental social unit was and still is the
  extended family.
• The extended families were large numbering in the
  hundreds, they were from the same village or
  clan.
• Today on Guam, as is with many other cultures
  the family includes everyone from Great
  Grandparents to the forth cousin twice removed,
  family can also include very close, but
  non-related friends.

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PINEKSAI(Reared)

• A common practice until after WWII, it is when
  the first child of the eldest child or the first
  grandchild was given to the grandparents to raise
  as a daughter or son.
• This was done to insure that when the
  grandparents become old and need assistance there
  would always be someone in the home to help them.

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A Matrilineal Society

• The mothers lineage determined ownership of
  property and land rights.
• The Priests disapprovingly reported
• ?
• in the home it is the mother that rules and her
  husband does not dare give an order contrary to
  her wishes, nor punish the children, for she will
  turn upon him and beat him.
• Spanish forcibly changed this female dominated
  lifestyle to a Western based patriarchy, -
• Can you imagine the culture shock that caused?

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Religious Beliefs

• Ancestor Worship venerating the spirits of
  those who came before.
• The Suruhanu Spirit Doctor healing the sick
• DANGEROUS SPIRITS
• Taotaomona the people of before
• Duendes Mischievous Elves
• Fanague To be visited by the ghost of a
  deceased relative
• Not considered to be unusual

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RESOURCES

• The resources of the ocean were not considered
  free for all.
• Outsiders who exploited family property owed
  compensation to the owners.
• The Spaniards and later the Americans were
  unaware or indifferent to this custom, which was
  the cause for many additional problems.
• Today there are still strong arguments for
  indigenous fishing rights.

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KNOWLEDGE

• A concept that was a surprise to the Europeans
  was that knowledge was considered to be private
  property and not shared with strangers.
• Some knowledge such as medicine or magic was
  considered more secret.
• Today many Pacific Islanders are often evasive or
  answer a question with what they assume will be
  pleasing, although not necessarily accurate, to
  the questioner.

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ISLAND CULTURE

• IMPACTED by TIME, TIDE, TYPHOON, EARTHQUAKE
• by political manipulations
• and by WAR.
•  Guam has never had a voice in its own destiny -
• In 1521 the island became a colony of Spain
• In 1898 Guam became an American colony as part
  of the spoils of the Spanish American war.
• On December 8, 1941 Guam was attacked and taken
  by the Imperial Forces of Japan.
• July 21, 1944 Guam was retaken by the Navy, Army
  and Marine Corps. Since then, Guam has been a
  Territorial possession of the United States of
  America.

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QUESTIONS?

• Information for this presentation was provided
  from a variety of sources
• I would especially like to thank
• ?Dr. Robert F. Rogers author of Destinys
  Landfall (1995 University of Hawaii Press)
• ?Mr. Jay J. Perez
• ?Ms. Bernie M. Rosario
• ?Mr. and Ms. Francisco Arceo and family
• (my Guam family)

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Thank you

• For further information conference
  presentations
• please visit
• www.consensusproject.org

This material was developed by presenters for the
July 2009 event Smart Responses in Tough Times
Achieving Better Outcomes for People with Mental
Illnesses Involved in the Criminal Justice
System. Presentations are not externally
reviewed for form or content and as such, the
statements within reflect the views of the
authors and should not be considered the official
position of the Bureau of Justice Assistance,
Justice Center, the members of the Council of
State Governments, or funding agencies supporting
the work.