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AND THE JOURNEY CONTINUES Achieving Cultural and
Linguistic Competence in Systems Serving Children
and Youth with Special Health Care Needs and
their Families
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Tawara D. Goode Wendy Jones National Center
for Cultural Competence Georgetown University
Center for Child and Human Development University
Center of Excellence in Developmental
Disabilities October 15, 2007
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Soliciting Stories from the Road

• the story collection process

• key partners and stakeholders

• methodology

• collaborators

Source And the Journey ContinuesAchieving
Cultural and Linguistic Competence in Systems
Serving Children Youth with Special Health Care
Needs and their Families. Goode, Jones, Dunn
Bronheim, 2007
Slide Source National Center for Cultural
Competence,2007
5
Soliciting Stories from the Road

• 23 stories from 18 states and 1 territory

MO, NJ, NM, NC, ND, OK, TN, UT, WA, WI
AK, CT, FL, GU, IL, KS, KY, MA, MS,
Source And the Journey ContinuesAchieving
Cultural and Linguistic Competence in Systems
Serving Children Youth with Special Health Care
Needs and their Families. Goode, Jones, Dunn
Bronheim, 2007
Slide Source National Center for Cultural
Competence,2007
6
How are the states and territories traveling?

• Many of the stories focused on varied aspects of
  linguistic competence, including
• increasing access to care and
• enhancing the capacity to respond to emerging
  populations speaking languages other than English

Source And the Journey ContinuesAchieving
Cultural and Linguistic Competence in Systems
Serving Children Youth with Special Health Care
Needs and their Families. Goode, Jones, Dunn
Bronheim, 2007
Slide Source National Center for Cultural
Competence,2007
7
How are the states and territories traveling?

• Policy- Most stories focused on compliance with
  federal and/or state policies related to language
  access.
• Structures- Stories reflected a trend in
  reinvigorating or using existing structures to
  plan for and implement enhanced language access
  services.

• Practices- an array of practices were identified
  that involved the use of technology, and training
  to build new skill sets for personnel.

Source And the Journey ContinuesAchieving
Cultural and Linguistic Competence in Systems
Serving Children Youth with Special Health Care
Needs and their Families. Goode, Jones, Dunn
Bronheim, 2007
Slide Source National Center for Cultural
Competence,2007
8
How are the states and territories traveling?

• Procedures- Several stories indicated development
  of new procedures for linguistic competence.
• Dedicated resources- None of the stories
  addressed budgetary or funding issues related to
  language access.

Source And the Journey ContinuesAchieving
Cultural and Linguistic Competence in Systems
Serving Children Youth with Special Health Care
Needs and their Families. Goode, Jones, Dunn
Bronheim, 2007
Slide Source National Center for Cultural
Competence,2007
9
How are the states and territories traveling?

• Value diversity- All stories demonstrated an
  understanding of and a value for diversity among
  populations served and personnel.
• Conduct self-assessment- several stories
  described engaging in organizational
  self-assessment resulting in changes in practice
  and procedures

• Manage the dynamics of difference- community
  partnerships, training and staff development were
  major strategies used to address difference.

Source And the Journey ContinuesAchieving
Cultural and Linguistic Competence in Systems
Serving Children Youth with Special Health Care
Needs and their Families. Goode, Jones, Dunn
Bronheim, 2007
Slide Source National Center for Cultural
Competence,2007
10
How are the states and territories traveling?

• Acquire and institutionalize cultural knowledge-
  Several stories documented initiatives to acquire
  knowledge and information about specific racial,
  cultural, and ethnic groups none of the stories
  described policies, structures and practices to
  institutionalize the function of acquiring
  cultural knowledge throughout the organization.

Source And the Journey ContinuesAchieving
Cultural and Linguistic Competence in Systems
Serving Children Youth with Special Health Care
Needs and their Families. Goode, Jones, Dunn
Bronheim, 2007
Slide Source National Center for Cultural
Competence,2007
11
How are the states and territories traveling?

• Adapt to diversity and the cultural contexts of
  communities served- All of the stories reflected
  a compelling need to adapt services for families
  and communities. None of the stories identified
  approaches to evaluate the effectiveness of
  service adaptations or policy changes necessary
  to sustain such efforts

Source And the Journey ContinuesAchieving
Cultural and Linguistic Competence in Systems
Serving Children Youth with Special Health Care
Needs and their Families. Goode, Jones, Dunn
Bronheim, 2007
Slide Source National Center for Cultural
Competence,2007
12
WATCH FOR SIGNS ALONG THE ROAD!!
Detour Stop Sign U-Turn Proceed with
Caution Hidden Entrance Work Zone Divided
Highway New Traffic Pattern Hazardous Driving
Conditions Watch for Pedestrians Cyclists Slow
Speed Toll Ahead
T.D. Goode
Slide Source National Center for Cultural
Competence,2007
13
LESSONS OF THE JOURNEY

• Leadership

• Shared Ownership

• The ISMs- Confronting the Undercurrents

• Keeping it Real

• Weave into the Fabric of the Organization

T.D. Goode
Slide Source National Center for Cultural
Competence,2007
14
LEADERSHIP

• cultivating leadership at all levels
• leaders (with without authority)
• revisiting the role of the leader

T.D. Goode
Slide Source National Center for Cultural
Competence,2007
15
Fears and Concerns about Cultural Linguistic
Competency
If I am asked to learn about cultural
competence, then they must be implying that I am
incompetent!
If I am authentic about this, I will stir up a
hornets nest in this place. Then there will be
repercussions. I am not willing to take that
risk.
I have examined studies about various cultures,
changed some of my thoughts, and now I feel
competent.
There are too many cultures. I cant possibly
learn about all of them. This is futile.
I am a person of color. I know what it means to
be culturally competent. I dont need any special
training.
If we really get into this my colleagues will
discover that I dont know as much as I think I
need to know.
I may discover I have more biases than I care to
admit.
Slide Source National Center for Cultural
Competence, 2007
16
Considering Cultural Linguistic Competence
within the Context of Organizational Change
Adaptive Challenge vs. Technical Challenge
Does making progress require changes in
peoples values, attitudes and or habits of
behaviors?
Reference Heifetz, R.A. (1994). Leadership
Without Easy Answers. Cambridge, MA The Belknap
Press of Harvard University Press
Slide Source National Center for Cultural
Competence,2007
17
The Work of the Leader

• Get on the Balcony
• Identify the Adaptive Challenge
• Regulate Distress
• Maintain Disciplined Attention
• Give the Work Back to the People
• Protect Voices from Below

Slide Source National Center for Cultural
Competence,2007
18
Leadership Lessons Learned

• Leadership to advance and sustain cultural and
  linguistic
• competence must be cultivated at all levels
  of
• an organization, system, or community.
• Some individuals lead through position, others
  through influence
• both are valued and necessary and must be
  recognized.
• The traditional role of the leader must be
  revisited and adapted
• to address ongoing or emerging challenges
  organizational
• change processes, differences across and
  within cultures and
• resulting dynamics, resistance, and
  differences in power.

Slide Source National Center for Cultural
Competence,2007
19
Are we on the same page?
Culturally aware
Cultural humility
Culturally relevant
Cultural sensitivity
Culturally competent
Culturally linguistically competent
Culturally appropriate
Multicultural Competence
Linguistically competent
Culturally effective
Cultural Proficiency
T.D. Goode
Slide Source National Center for Cultural
Competence,2007
20
SHARED OWNERSHIP

• on the same page
• (conceptual frameworks definitions)
• Oh thats only for people of color.
• the indispensable opposition
• getting buy in

T.D. Goode
Slide Source National Center for Cultural
Competence,2007
21
Shared Ownership Lessons Learned

• Staff, families, community partners, and key
  stakeholder need to
• be on the same page with a shared
  understanding of the conceptual
• frameworks and benefits of cultural and
  linguistic competence.
• Culturally and linguistically competent health
  and mental health
• systems and organizations should involve and
  benefit all.
• Structures to advance and sustain cultural and
  linguistic competence
• must be inclusive to be effective.

Slide Source National Center for Cultural
Competence,2007
22
THE ISMs Confronting the Undercurrents

• Call it what it is!
• create a climate of intolerance
• offer a safe refuge for authentic discussions
• use conflict management resolution
• invoke legal interventions when necessary

T.D. Goode
Slide Source National Center for Cultural
Competence,2007
23
The ISMs Lessons Learned

• Addressing racial and ethnic disparities in
  health and mental health
• care demands an intentional focus on conscious
  or unconscious bias, prejudice, stereotyping,
  and discrimination.
• Efforts to advance and sustain cultural and
  linguistic competence
• will have little or no success unless the
  ISMs are confronted
• with integrity, in a humane and effective
  manner.

Slide Source National Center for Cultural
Competence,2007
24
Organizational Change Theories Applied to
Cultural Linguistic Competence
Resistance is a characteristic of any major
organizational change effort and a major reason
why organizational change efforts fail.
(Prochaska, Prochaska and Levesque, 2001).
Resistance should be expected in different stages
of multicultural organizational change because
the topics of prejudice, discrimination and
oppression are controversial and emotionally
charged. (Brantley, Frost and Razak, 1996).
The Transtheoretical Model of Change suggests
that it is counterproductive to forge ahead with
action without addressing issues such as
resistance, that stand in the way of individual
and organizational readiness for change.
Data Source Mayeno, L. Multicultural
Organizational Development A Resource for Health
Equity, in Cultural Competence in Health Care
Series, The California Endowment and Compasspoint
Nonprofit Services, April 2007.
Slide Source National Center for Cultural
Competence,2007
25
KEEPING IT REAL

• create nurture a community of learners
• make training relevant
• tailor to individual interests, preferences
  needs
• incorporate into specific job functions
• performance measures
• offer incentives

T.D. Goode
Slide Source National Center for Cultural
Competence,2007
26
Keeping it Real Lessons Learned

• Create and nurture a community of learners as
  part of the organizations commitment
• to promote continuous professional growth and
  development for staff, volunteers,
• and board members to acquire the knowledge and
  skills necessary to advance and
• sustain cultural and linguistic competence.
• Provide highly relevant training and technical
  assistance based on individual interests,
• needs, and preferred learning methods of
  staff. Consider formal and informal learning
• opportunities, such as continuing
  education/academic courses, coaching, mentoring,
• shadowing, language instruction, book clubs,
  visiting scholar/practitioner programs,
• and other experiential activities.

Slide Source National Center for Cultural
Competence,2007
27
Keeping it Real Lessons Learned

• Revisit position descriptions and job functions
  to ensure they define the qualities,
• experience, knowledge, and skills sets needed
  to promote culturally and linguistically
• competent services and supports.
• Establish a system of incentives that
  acknowledges and celebrates staff efforts
• and achievements in advancing and sustaining
  cultural and linguistic competence.

Slide Source National Center for Cultural
Competence,2007
28
Weave into the Fabric of the Organization

• eliminate the perception of add on
• establish the business case
• link to quality of care
• legitimize in policy, structures,
• practices, procedures, resources
• set bench marks measure progress
• at regular intervals
• assure it is woven into the culture of
• the organization

T.D. Goode
Slide Source National Center for Cultural
Competence,2007
29
Weave into the Fabric of the Organization and
Lessons Learned

• Eliminate the perception of cultural and
  linguistic competence as add-ons by
• ensuring principles and practices are woven
  into the culture of the system or organization.
• Establish a clear business case for cultural and
  linguistic competence within the
• specific contexts of the system, organization
  or program.
• Promote the understanding that cultural and
  linguistic competence are integrally linked
• to quality of careyou cant have one without
  the other.
• Institutionalize cultural and linguistic
  competence in policies, structures,
• practices, procedures and dedicated resources
  within systems and organizations.
• Establish bench marks and measure progress at
  regular intervals.

Slide Source National Center for Cultural
Competence,2007
30
What are the leadership implications for cultural
linguistic related to

• CORE FUNCTIONS
• What we do ..
• HUMAN RESOURCES STAFF DEVELOPMENT
• Who we are
• FISCAL RESOURCES ALLOCATION
• Where the money goes
• COLLABORATION COMMUNITY ENGAGEMENT
• Who our partners are
• CONTRACTS
• Whom do we entrust to deliver services and
  supports

Data Source Excerpt from Planning for cultural
and linguistic competence in State Title V
programs serving children and youth with special
health care needs and their families , NCCC, 2004
T.D. Goode
Slide Source National Center for Cultural
Competence,2007
31
Cultural and linguistic competence Its a lifes
journey not a destination Safe travels!
T.D. Goode Slide Source National Center for
Cultural Competence, 2007