National" Standards for Culturally and Linguistically Appropriate Services in Health Care"

We thought it would be a good idea to comment and expand on each of the 14 Standards CLAS. We will begin with Standard 1:

"Health care organizations should ensure that patients/consumers receive from all staff members effective, understandable, and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language."

From an organizational perspective, leadership needs to take the primary role in ensuring that all patients/consumers are treated with respect, and services are provided in accordance to their cultural health beliefs, practices, and preferred language. An organization’s leadership serves as a role model for staff to understand, implement, and practice best culturally and linguistic strategies that give results. Health care organizations should create a culture that opens lines of communication among staff and patients, and it is sensitive to the cultural and linguistic needs of the individuals served. It is important to note that cultural competence or understanding cultural competence is not only related to knowing and learning about ethnic or racial groups that migrate to North America. It is also about understanding the cultural nuances and practices of a single population, for instance in North America, Caucasians have difference cultural differences, if you live in the South even the accent varies from those living in the Northeast. In some words, cultural and linguistic competence is about respecting individuals or groups own way of communication and their practices, and approaches to life. Respect is one of the most basic good sense practices that an individual can perform in order to interact with another person. However, cultural and linguistic competence should be a “Mirror Effect” meaning that patients also should invest time in learning about the different cultures that are found in North America such as the society, language, health care system, services, and resources such as organizations. It cannot be one direction, it is should be a “Mirror Effect” for patient’s best interest, benefit, and safety.



Source: National Standards for Culturally and Linguistically Appropriate Services
in Health Care. FINAL REPORT U.S. Department of Health and Human Services Office of Minority Health. March 2001.

Author:
Helen E. Dao is the President and CEO at her company Dao Management Consulting Services, Inc. (www.daoconsultingservices.com) Helen has been working on cultural diversity and public health strategies development for 11 years. You can follow her on Twitter @ http://twitter.com/#!/daoconsulting and @ her blog http://daoconsultingservices.blogspot.com/

Cultural Knowledge a Key Competency in Care Coordination

A Program Created for Care Coordinators

At DAO we understand how important it is to have well-trained staff responsible for coordinating all the patient/consumer’s health care needs. Care coordination is the centerpiece of individual and family access and continuity of optimal health care services.

We implement a pioneering cultural and linguistic competence approach that goes beyond the one-dimensional instructional model. Our proven model has helped health care organizations, social service organizations and other community-based organizations achieve effective care coordination strategies. Our model is backed by cultural and health science knowledge, and promotes cognitive learning (critical thinking about the benefits of intercultural communication) and affective learning (creating values and behavior that illustrate intercultural communication).

We not only use proven models and strategies, we integrate lessons learned from the field and actual case studies.

For more information about this program, please go to:

http://daoconsultingservices.com/index.php?option=com_content&view=article&id=22:a-program-created-for-care-coordinators&catid=2:latest-news

Helen Dao, MHA

DAO in the News!

Just want to share with our readers on some of the ongoing work that we are doing on cultural competence, locally and nationally.

http://www.northjersey.com/news/131732788_Resident_spreads_message_of__cultural_competence_.html?c=y&page=1


Helen Dao, MHA

Care Coordination Series - Part I

Cultural Knowledge a Key Competency in Care Coordination Part I

We begin this series by highlighting the function of care coordination.  A care coordinator coordinates and links patients to services and resources in a cohesive and coordinated manner to achieve optimal and continues health care.

Extensive literature describes care coordination as a core component of patient-centered approach by providing coordination of care, referral and follow-up, and quality improvement driven. 

Many initiatives are in progress at the local, state, and federal level with the single goal of containing health care cost.  Patient-centered medical home and health home are some of those initiatives, no matter what we call it; it boils down to the provision of patient-centered care though care coordination. 

As many literature reviews show it, care coordination is the key to coordinate and monitor patient’s access, services, and monitoring of health care services.

One main factor that needs to be considered is the appropriate training of care coordinators; it can be one individual or the entire care team.  No matter which model is used, care coordination should emphasize cultural understanding and strategies for being more effective while working with multicultural populations.

Here are some tips:

•                Identify the population that you are or will work with?

•                Identify for sub-cultures within a single population

•                Identify potential cultural and linguistic barriers 

•                Identify health literature and literacy concerns

•                Be aware of cultural nuances

•                Understand family's dynamics within the culture context

•                Understand families cultural perception and beliefs toward specific illnesses

•                Create a framework for a care plan that meets health history, family dynamics, traditional           and non-traditional treatments, social, educational, quality of life, safety, and culture.

•                Identify and access internal and external resources

•                Use simple language when communicating medical definitions and information

There are many other elements that we can identify when framing a care coordinator competencies.  But if you follow the above framework, it will get you started on the right path.

Author

Helen E. Dao is the President and CEO at her company Dao Management Consulting Services, Inc. (www.daoconsultingservices.com) Helen has been working on cultural diversity and public health strategies development for 11 years.  You can follow her on Twitter @ http://twitter.com/#!/daoconsulting  and @ her blog http://daoconsultingservices.blogspot.com/

 

The Functionality of a Cultural Broker and a Health Educator in Multicultural Communities

(This article is a revised version from the one published online June 10, 2011 by author)

Health educators have the opportunity of being agents of change, mediators, cultural brokers, and catalyst.  Hospitals, community health centers, individual practitioners, community health educators are implementing a variety of strategies to effectively communicate with patients/consumers.  How we approach this is a matter of deciding which strategies work best in different settings.  There are two ways that have proven to be effective in enhancing communication with patient/consumers, cultural broker and health promoter/promotora.  However, it is important to know the functionality of these roles.  A cultural broker and a community health educator have similar goals and responsibilities, but it is important to understand the differences in training, knowledge and needed skills.

To read full article copy and paste below link.

http://knol.google.com/k/helen-dao/the-functionality-of-a-cultural-broker/1kq8x54vjej41/5#

Integrating Cultural Competence Strategies in Community-Based Settings

Cultural Competence Strategies can be as complicated or simple as we want them to be.  Sometimes going back to basics makes more sense then testing complicated models that create, sometimes more confusion.  One of the strategies that I am very passionate about is Cultural Brokering, it allows health care professionals and communities come together and find a common ground.  On September 27th from 10:00 am - 12:00 pm, I will be doing a workshop at UMDNJ School of Public Health, for those of you who are local, I invite you to attend.

Program Location:
UMDNJ-School of Public Health Building
683 Hoes Lane West, 1st Floor, Room 135, PO Box 9
Piscataway, NJ 08854

Phone (732) 445-9700

www.sph.umdnj.edu/

Revised Title "Curanderismo: Healing Holistically in Latino Communities"

The article name has been changed to "Curanderismo: Healing
Holistically in Latino Communities"


Curanderismo is a Latino holistic — mind, body and soul — approach to health, originating from the early colonial period Catholicism and pre-Columbian indigenous medicinal practices in Latin America. Because of the widespread dissemination of Catholicism during the early Spanish conquests of Mexico, the Caribbean, Central and South Americas, most Latinos are familiar with the basic practices and precepts of curanderismo. Within these geographical regions, there is diversity from one nation to another as well as intraethnic diversity in the practices and beliefs of curanderismo. Also known as Mexican folk medicine in the Southwestern U.S., it incorporates physical as well as spiritual and soul-related explanatory models of health and illness. There are no discrete lines between physical and mental health, similar in this respect to some traditional Eastern medicinal views. Treatable ailments encompass social, emotional, mental and physical problems.

A curandero, "male healer" in Spanish (or a curandera, “female healer” in Spanish), is often a respected and revered elder with spiritual gifts, whose job it is to tend to the health and psycho-spiritual needs of his community. Typically full of compassion, affection and good will, this person is an essential member of the local community who develops life-long bonds with the families he/she serves. He or she is the first person who people turn to in crisis, distress or spiritual discontentment, seeking consolation, understanding and, in some cases, divination. Prescribed treatments can range from herbs, massage, manipulation of body parts, spiritual rituals, exorcisms, and prayer — in combination or singly. A curandero consults and treats the entire family for an issue affecting one individual in the household as the ailment, curse, or spiritual issue may be viewed as affecting all members of the family.

Medical anthropologist Renaldo Maduro, PhD, states in his article, “Curanderismo and Latino Views of Disease and Curing,”  West J Med. 1983 December; 139(6): 868–874 that:

“There are eight major philosophical premises underlie a coherent curing world view of Latino patients: disease or illness may follow..

(1) strong emotional states (such as rage, fear, envy or mourning of painful  

      loss) or

(2) being out of balance or harmony with one's environment;

(3) a patient is often the innocent victim of malevolent forces;

(4) the soul may become separated from the body (loss of soul);

(5) cure requires the participation of the entire family;

(6) the natural world is not always distinguishable from the supernatural;

(7) sickness often serves the social function, through increased attention and rallying of the family around a patient, of reestablishing a sense of belonging (resocialization) and

(8) Latinos respond better to an open interaction with their healer.”

While many Latino-Americans believe in curanderismo as a healing modality, most also value the power of conventional Western medicine, routinely seeking the care of a medical doctor when sick, according to one Los Angeles study. In one particular area of Los Angeles, most Mexican-Americans sought medical treatment for their mental illness, rather than seeking the care of a curandero. Though curanderismo is, and has historically been, an inherent part of Latino culture, it would be incorrect to presume that every Latino embraces the beliefs and practices of curanderismo. Some understand it as folk medicine, which means that they see value in it for certain ailments while they feel other issues may require attention from allopathic professionals.

            In other academic research, curanderismo is postulated to be the reason why Latino-Americans are underrepresented in California’s mental health system, constituting only 3% of the patient population when they constitute more than 10% of the state’s general population. Dr. Maduro hypothesizes that many Latinos often are consoled and taken care of by their local curandero and their family, protective mitigating factors in mental health.
            If health care providers are to maintain their effectiveness, their knowledge of their patient’s cultural milieu is critical in the delivery of care. Understanding a patient's explanatory model of illness enables providers to formulate a culturally appropriate response, and also anticipate, identify and resolve any potential treatment compliance issues before problems arise. For example, if a person believes his mental illness is a result of a curse or spirits, he may choose not take his medication. A person’s explanatory model of his illness affects their health-related behaviors and their willingness to comply with treatment plans. By 2050, the largest ethnic minority in the U.S. will be Latino-Americans with 29% of the population, who currently constitute about 14%.

What do you think about curanderismo?  How you witnessed any spiritual practice?  Please share your thoughts.

Guest Blogger:
Pearl Ji-hyon Park
lightfisharts@gmail.com
Please visit our website: amongourkin.org.
Blog: can-documentary.blogspot.com

The difference Between a Cultural Broker and a Community Health Worker

The difference Between a Cultural Broker and a Community Health Worker

The difference is that cultural brokers are individuals who do not need a formal certification.  A cultural broker can be a doctor, a nurse, front desk staff, patient’s relative, clergy, in some cases which is not preferable, children.  Have said that it is important to understand that a cultural broker depending at what level they are needed, they will need extensive training in understanding and building skills as a cultural broker in order to work with a specific ethnic groups of individuals. 

A community health worker needs a certification or a more formal training in order to perform this task here is the link to the Texas Department of State health Services www.dshs.state.tx.us/mch/chw.shtm, here you can see the application.  It contains information on the core sections of the training curriculum.

However, both a cultural broker and a community health work have many things in common such as training specific in communication, advocacy, bilingual skills, provide culturally and linguistic appropriate health education, serve as mediators, and others.

A cultural broker focuses more on how he/she can bridge the gap of communication between patient and the health care system (health care providers) through knowledge and understanding of cultures by serving as a mediator of agent of change.  There is a lot of intensive training on cultural and linguistic competency for non-natural support systems such as family.  Here is the link to the National Center for Cultural competence which provides a case of cultural brokering between Western health care professionals and healer or shaman Hmong http://www.culturalbroker.info/appendix_A/3_appendixA.html.

One point I want to make is that cultural brokering is becoming not exclusive to HCO but also human and social community-based organizations trying to reach their consumers.

Here are a few definitions of a cultural broker and a community health worker:

The goal of the Cultural Broker Project is in keeping with the NCCC’s overall mission to “increase the capacity of health care and mental health programs to design, implement and evaluate culturally and linguistically competent service delivery systems.” Cultural and linguistic competence have emerged as fundamental approaches to the goal of eliminating racial and ethnic disparities in health. A major principle of cultural competence involves working in conjunction with natural, informal supports and helping networks within diverse communities (Cross et al., 1989).

A Promotor(a) or Community Health Worker is a person who provides cultural mediation between their communities and health and human service systems. They are a bi-lingual/cultural liaison between patients and healthcare providers through activities that include assisting in case conferences, providing linguistically and culturally appropriate health education, informal counseling, and social support; advocates for individual and community needs; assures people get the services they need; builds individual and community capacity; and provides referral and follow-up services (Colorado 

Institute of Public Policy, 2007).

Cultural Brokers (CB) are navigators and bridge the cultural gap between communities and the formal healthcare system. CB, like Community Health Workers, are drawn from the community they serve though their backgrounds are highly variable. Some CBs are immigrant children who live in two cultures daily. Some are leaders of advocacy organizations. Training may be extensive or non-existent. The need for CBs is only increasing as the U.S. population is diversifying and health disparities persist. A Cultural Broker fulfills a variety of roles. They serve as

·     Liaisons between (1) the family/community’s health values, beliefs and practices and (2) the healthcare system.

·     Cultural guides who understand the strengths and needs of a community but also know about the structures and functions of the healthcare setting.

·     Mediators who help establish and maintain trust with communities and build relationships between the patient and medical provider.

·     Advocates for change of the healthcare system by virtue of the work they do for communities and with the medical community (National Health Service Corps, 2004).

References

1.     Cultural Responsiveness: Social-Emotional Health of Young Children, Birth – 5 Years of Age: Research, Policy and Financing

Link: www.denverearlychildhood.org/.../D%205%20DECC%20Report%20Chapter%202%2011.18.09.pdf

2.     National Center for Cultural Competence: Bridging the Cultural Divide in Health Care Settings

Link: http://www.culturalbroker.info/appendix_A/3_appendixA.html

For more information contact Helen Dao, MHA at Helen@daoconsultingservices.com

Diversity, Inclusion, Cultural Competence and Linguistic Competence, What Do They Mean?

For decades we have heard the concept "Diversity". In today's businesses, diversity has a much different meaning then before.  Another concept that is taking a strong force is Cultural Competence. There is a clear difference between Diversity and Cultural Competence, however, they are used interchangeably.  Diversity is the distinction of race, ethnicity, nationality, culture, religion, age.  Cultural Competence is a working definition, there are an array to choose from, cultural competence is the set of values, traditions, beliefs, and systems that group of people share.

Another definition that is very important to know and understand is linguistic competence.  The definition of cultural competence by the National Center of Cultural Competence is the ability of an organization and its personnel to understand and convey information that is easily understood by individuals, including Limited English Proficiency. Now let's go back to Diversity and Inclusion at the Workplace.  There cannot be diversity and inclusion without cultural and linguistic competence at the workplace.  Businesses and organizations must pay attention to the cultural differences  among their employees and how it affects management and staff communication as well peer interaction.

Let's look at the following situation.  HR hires a Chinese community educator to train the Chinese community on a specific health condition.  Management ask the educator to develop an educational curriculum for the trainings.  The educator is asked to implement the curriculum in a bilingual format.  The educator asked management in what Chinese dialect should he deliver the training?  Management response is, well you are Chinese, don't you speak Chinese?  The educator responds yes, but I only speak Cantones.  Management finds out that the Chinese community center's patients, the majority speaks Mandarin, two different dialects.

The lesson learned: Businesses and organizations should not make assumptions about their employees' culture and language base on their race or ethnicity.  Therefore, we must move beyond diversity and inclusion, cultural and linguistic competence knowledge is a requirement to do and stay in business.

For more information contact Helen Dao at helen@daoconsultingservices.com.

Announcement!

Helen Dao will be a guest speaker at The University of Medicine
and Dentistry of New Jersey-School of Public Health (UMDNJ-SPH) presenting on "Multicultural Health in Public Health Practice"

Date: May 25, 2011
Place: UMDNJ- School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854
Time: 10:30 AM - 12:00 PM

The face of North America has changed and continues to change.  Currently, there are almost 45 million people in the nation who speak a language other than English, and over 30 million who were born outside of the United States.  During the past decade, the number of Spanish and Asian language speakers grew by 50 percent.  Community clinics and health centers are in the position of improving quality of care through the understanding of cultural competence and the implementation of Limited English Proficiency (LEP) strategies in public health practice. This seminar will discuss cultural competence in public health.

Helen will review a definition for cultural competency and its applicability to public health. This seminar will address the barriers to culturally competent care such as: Lack of diversity in health care's leadership and workforce; systems of care poorly designed to meet the needs of diverse patient populations; and poor communication between providers and patients.

For Registration On-line copy and paste the following link into your browser to register on line

https://ophp.umdnj.edu/wconnect/CourseStatus.awp?&course=PHSS041311

Or you can register by telephone. Call Carl Donaldson at (732) 235-9451. All seminars are held from 10:30 AM to 12:00 PM at UMNDJ School of Public Health, 683 Hoes Lane West, Piscataway, NJ. All seminars carry 1.5 CEU, 1.5 CHES, 1.5 Nurse Contact Hours.

We are taking a different approach at DAO

Dear Reader,

At Dao, we are getting ready to start a Theme Blog Campaign for the rest of 2011!!!

May, we will focus on Diversity & Inclusion at the Workplace (These topics will be health care, social and human services workforce related).

June, we will be providing the latest on revolution of cultural and linguistic competence trends, how changes take place, and how affect the care of minority groups in America.

July, Public Health Practice, based on true community stories.

August, Cultural Broker/Cultural Health Broker (partnering with health care providers in the behavioral change/modification of resistance to treatment).

We will have special guest writers through out the year!

Soon, we will be announcing the themes for September, November, and December!

Helen Dao