Cultural competence in DMH Planning

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Cultural competence in DMH Planning

• Sarah Powell, MA
• Temple University
• Center for Preparedness Research, Education and
  Practice

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Definitions

• Culture
• refers to the shared attributes of a group of
  people broadly defined as a common heritage or
  learned set of beliefs, norms, and values
  (includes concepts of race ethnicity)
• Ethnicity
• Refers to a common heritage of a particular
  group (history, language, rituals, music, foods)
• Race
• social category classification of people based
  on a set of characteristics that are socially
  important

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Definitions

• Diversity within Racial and Ethnic Minority
  Groups
• American Indians and Alaska Natives may belong to
  more than 500 tribes, each of which has a
  different cultural tradition, language, and
  ancestry.
• Asian Americans and Pacific Islanders may
  identify with any of 43 subgroups and speak any
  of 100 languages and dialects.
• Hispanics may be of Mexican, Puerto Rican, Cuban,
  Central and South American, or other heritage

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Definitions

• Cultural Competence
• A set of values, behaviors, attitudes, and
  practices that enables an organization or
  individual to work effectively across cultures
  the ability to honor and respect the beliefs,
  language, interpersonal styles, and behaviors of
  individuals and families receiving services as
  well as of staff who are providing such services
  

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Cultural Competence Continuum

• Cultural Destructiveness
• Cultural Incapacity
• Cultural Blindness
• Cultural Pre-competence
• Cultural Competence
• Cultural Proficiency

Where does your organization fit?
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Cultural Competence Continuum

• Not just a matter of being politically correct,
  of assigning one person to attend to diversity
  issues or simply translating documents into other
  languages
• It is an ongoing process of organizational and
  individual development that includes learning
  more about our own and other cultures, altering
  our thinking about culture, and changing the ways
  in which we interact to reflect an awareness of
  and sensitivity to diverse cultures

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Disaster Mental Health Services
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Disaster Mental Health Services

• DMH services are MOST effective when survivors
  receive assistance that is in accord with their
  cultural beliefs and consistent with their needs.
  
• A focus on cultural competence should be
  integrated into planning and response from the
  very beginning in order to overcome barriers of
  language, culture, isolation, and mistrust

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Disaster Mental Health Services

• Importance of Community
• Lens through which its members view interpret a
  disaster
• Degree of cohesion determines level of social
  support
• Often extremely important for racial and ethnic
  minority groups may affect ability to recover
  from disaster (refugees, isolated groups)

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Disaster Mental Health Services

• Racism and Discrimination
• Legally sanctioned and more subtle forms of
  racism/discrimination
• Minority groups may distrust offers of outside
  assistance they may be unfamiliar with
  sociocultural mechanisms of receiving assistance
• Minority groups can face the brunt of anger
  /blame for a disaster results in increased
  stress

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Disaster Mental Health Services

• Social and Economic Inequality
• Poverty disproportionately affects minority
  groups
• Reduced access to community resources
• Higher rates of homelessness, substance abuse,
  crime
• More susceptible to disaster
• Lack of transportation can be a barrier to access
• Lack of familiarity with sources of community
  support
• Less cultural capital to maneuver within the
  system
• Unwillingness to disclose (illegal) immigrant
  status

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Characteristics of Disasters

• The following are important when assessing
  emotional distress recovery
• Intensity of the Impact
• Impact ratio (i.e. the proportion of the
  community sustaining personal losses)
• Potential for recurrence of other hazards
• Cultural Symbolic aspects
• Extent types of loss sustained by survivors

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Disaster Planning
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Disaster Planning

• Considerations
• Community demographic characteristics
• Cultural Groups/ Special needs populations
• Socioeconomic Factors
• Mental Health resources
• Government roles responsibilities
• Nongovernmental orgs roles responsibilities
• Community Partnerships
• See handout at the front of binders

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Disaster Planning

• To develop a culturally competent disaster plan
• Assess and understand the communitys composition
• Identify culture-related needs of the community
• Be knowledgeable about formal and informal
  community institutions that can help meet diverse
  mental health needs
• Gather information from and establish working
  relationships with trusted organizations, service
  providers, and cultural group leaders and
  gatekeepers
• Anticipate and identify solutions to cultural
  problems that may arise in the event of a
  disaster

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Disaster Planning

• Guiding principles for cultural competence in
  DMH Programs
• Principle 1 Recognize the importance of culture
  and respect diversity.
• Principle 2 Maintain a current profile of the
  cultural composition of the community.
• Principle 3 Recruit disaster workers who are
  representative of the community or service area.
• Principle 4 Provide ongoing cultural competence
  training to disaster mental health staff.
• Principle 5 Ensure that services are accessible,
  appropriate, and equitable.
• Principle 6 Recognize the role of help-seeking
  behaviors, customs and traditions, and natural
  support networks.
• Principle 7 Involve as cultural brokers
  community leaders and organizations representing
  diverse cultural groups.
• Principle 8 Ensure that services and information
  are culturally and linguistically competent.
• Principle 9 Assess and evaluate the programs
  level of cultural competence.

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Disaster Planning

• Principle 1 Recognize the importance of culture
  and respect diversity.
• Diversity exists within as well as across
  cultures
• Diversity between generations
• Different levels of acculturation
• Biculturalism

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Disaster Planning

• Considerations when Interacting with People of
  Other Cultures
• Communication verbal nonverbal
• Personal Space look for clues
• Social Organization questions about hobbies
  social activities can lead to insights
• Time counselors may set timeframes that are not
  realistic to a survivor
• Environmental Control belief that events are
  caused by an outside factor (may affect recovery)

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Disaster Planning

• Principle 2 Maintain a current profile of the
  cultural composition of the community
• Race ethnicity
• Age
• Gender
• Religion
• Immigrant Refugee status
• Housing status
• Income poverty levels

• Percentage of residents living in rural v. urban
  areas
• Unemployment rate
• Languages dialects spoken
• Literacy levels
• Number of schools
• Number types of businesses
• History of racial relations/ ethnic issues in the
  community
• Information about the values, beliefs, etc. of
  local cultural groups

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Disaster Planning

• Principle 3 Recruit disaster workers who are
  representative of the community or service area.
• Cultural representatives should be involved in
  planning, policy, administration, management
  service delivery
• Community profile needs input from
  representatives
• Language does not equal cultural literacy or
  competence

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Disaster Planning

• Principle 4 Provide ongoing cultural competence
  training to disaster mental health staff.
• Training, provided in collaboration w/
  community-based groups, should include
• Cultural values traditions
• Family values
• Linguistics literacy
• Immigration experiences status
• Help-seeking behaviors
• Cross-cultural outreach techniques strategies
• Avoidance of stereotypes, labels and
  essentializing

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Disaster Planning

• Principle 5 Ensure that services are accessible,
  appropriate, and equitable.
• Reluctance to take advantage of services
• Illegal immigrants fear of deportation
• Inequitable treatment following disasters
  reinforce distrust
• Stigma associated with mental health services
• Culturally appropriate pre-incident education
  community partnerships can help alleviate
  distrust during an actual disaster

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Disaster Planning

• Principle 6 Recognize the role of help-seeking
  behaviors, customs and traditions, and natural
  support networks.
• Help-seeking Behaviors preferences about where
  to seek assistance fears about seeking help
• Customs and Traditions in Trauma and Loss
  beliefs may influence perceptions about cause
  diversity in handling grief
• Customs and Traditions for Healing beliefs
  about illness healing integrate trad. methods
  of healing into services loss of ritual spaces
  culturally appropriate anniversary activities
• Natural Support Networks recognize family/kin
  groups help friends family to reunite
  individualism does not exist cross-culturally
  (outreach targeting individuals may not be
  effective)

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Disaster Planning

• Principle 7 Involve as cultural brokers
  community leaders and organizations representing
  diverse cultural groups.
• Vital to the success of disaster relief efforts
• Leaders w/insider knowledge of the community
• Organizations representing various cultural
  groups
• Include Civic associations, social clubs,
  neighborhood groups, faith-based orgs, voluntary
  orgs, advocacy orgs, service providers, etc

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Disaster Planning

• Principle 8 Ensure that services and information
  are culturally and linguistically competent.
• Non-English speakers may not be able to receive
  needed food, medical supplies, and disaster
  mental health assistance
• Availability of trained bilingual and bicultural
  staff, translations of educational materials,
  language and sign language interpretation

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Disaster Planning

• Principle 9 Assess and evaluate the programs
  level of cultural competence.
• Leadership
• Understanding of cultural competence
• Organizational Culture
• Training
• Cultural Competence Plan
• Managing the Plan

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Case Studies

• Issues of Culture/ Ethnicity in VA post 9-11
• Backlash on ethnic groups of middle eastern
  heritage
• Law enforcement practices assed to experience of
  discrimination/ suspicion
• Essentializing or stereotyping diverse groups
  of people based on set of characteristics
• Community Leaders involved in CCP very
  successful outreach

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Case Studies

• Pandemic Flu/ Biological Event
• Mass Prophylaxis/Dispensing
• Mistrust of govt Adversity to self reporting
  Instructions may be confusing or unintelligible
• Quarantine
• Usually does not work massive flight policies
  may cause sense of discrimination
• Isolation
• Fear of losing ones job low socioeconomic
  status more at risk Instructions must reach all
  language groups be understood for effective
  public health measures

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Further Discussion

• What other issues are likely to arise in the
  event of a pandemic?
• What planning considerations MUST take place
  ahead of time?
• What cultural groups are at higher risk in your
  county/city?

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Questions
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Cultural competence in DMH Planning

• Developing Cultural Competence in Disaster
  Mental Health Programs Guiding Principles and
  Recommendations (2003) U.S. Dept of Health and
  Human Services, SAMHSA, Center for Mental Health
  Services, www.samhsa.org