Cultural Competence Plan

Goal - why is this important to us? 

In order to reduce barriers to effective treatment and recovery support, Dawn Farm must assess the organization’s cultural competence as well as the cultural diversity among the people and community we serve.

Cultural Competence Vision Statement

Dawn Farm seeks to identify and remove barriers that prevent addicts and alcoholics from joining the recovering community. Dawn Farm seeks to achieve this mission with addicts and alcoholics of all backgrounds and cultural identities. Further, to achieve this mission, Dawn Farm must maintain strong ties to the community and most importantly, the recovering community. Dawn Farm’s interactions with clients, the recovering community, and the larger community will be characterized by dignity, respect and sensitivity.

Definitions

[From A Provider's Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual, & Transgender Individuals (2001, SAMHSA/CSAT) BKD392]

Culture: Culture refers to the customary beliefs, social norms, and material traits of a racial, religious, or social group. It affects the group members’ viewpoints: how they act; how they think; and how they see themselves in relation to the rest of the world. Culture is transmitted through language, symbols, and rituals.

Ethnicity: Ethnicity describes a population or group having a common cultural heritage that is distinguished by customs, characteristics, language, and common history.

Diversity: Diversity refers to differences in geographic location (rural, urban), sexual orientation, age, religion or spiritual practice, socioeconomic status, and physical and mental capacity.

Culture of Recovery: A social network of recovering people that collectively nurtures and supports long-term recovery from behavioral health disorders. This culture has its own recovery-based history, language, rituals, symbols, literature, institutions (places), and values. It affords a particularly helpful reconstruction of personal identity and social relationships for those extracting themselves from deep enmeshment within drug and criminal subcultures.

Cultural Competence: Cultural competency is a set of academic and interpersonal skills that assists individuals in increasing their understanding and appreciation of cultural differences and similarities within, among, and between groups (Woll, 1996). It requires a willingness and an ability to draw on community-based values, traditions, and customs and to work with knowledgeable persons of and from the community in developing focused interventions, communications, and other supports. A culturally competent program is defined by CSAT (1994a) as one that demonstrates sensitivity and understanding of cultural differences in treatment and program design, implementation, and evaluation. Within the treatment setting, cultural competency is a fundamental component that helps individuals develop trust as well as an understanding of the way members of different cultural groups define health, illness, and health care (Gordon, 1994).

Substance abuse treatment providers may use their understanding of the client and the client’s cultural context to develop a culturally appropriate assessment, identify problems, and choose appropriate treatment strategies for the client. A culturally competent model of treatment acknowledges the client’s cultural strengths, values, and experiences while encouraging behavioral and attitudinal change.

Treatment services that are culturally responsive are characterized by the following:

• Staff knowledge of the client’s first language

• Staff sensitivity to the cultural nuances of the client population

• Staff backgrounds representative of those of the client population

• Treatment modalities that reflect the cultural values and treatment needs of the client population

• Representation of the client population in decision making and policy implementation.

These aspects alone do not constitute cultural competency, nor do they automatically create a culturally competent system. Culturally competent systems include both professional behavioral norms for treatment staff and the organizational norms that are built into the organization’s mission, structure, management, personnel, program design, and treatment protocols. In other words, culturally competent systems need to implement cultural competency in attitudes, practices, policies, and structures (Mason, 1995).

Interpreting behavior without considering its cultural context can lead to poor, sometimes detrimental, treatment outcomes. The covert prejudice of the treatment staff and language and cultural differences undermine efforts to help clients recover from substance abuse (CSAT, 1999b). However, if practitioners are to move from accommodation to inclusion in their helping practices, they must alter practices to meet the needs of their clients.

The Cultural Proficiency Continuum

(adapted from Cross, 1999)

There are six points along the cultural proficiency continuum that indicate unique ways of seeing and responding to difference:

• Cultural destructiveness: See the difference, stomp it out.

  • The elimination of other people's cultures

• Cultural incapacity: See the difference, make it wrong:

  • Belief in the superiority of one's culture and behavior that disempowers another's culture

• Cultural blindness: See the difference, act like you don't:

  • Acting as if the cultural differences you see do not matter or not recognizing that there are differences among and between cultures

• Cultural pre-competence: See the difference, respond inadequately

  • Awareness of the limitations of one's skills or an organization's practices when interacting with other cultural groups

• Cultural competence: See the difference, understand the difference that difference makes

  • Interacting with other cultural groups using the five essential elements of cultural proficiency as the standard for individual behavior and organizational practices

• Cultural proficiency: See the differences and respond effectively in a variety of environments

  • Esteeming culture; knowing how to learn about individual and organizational culture; interacting effectively in a variety of cultural environments

Current Population Served

Dawn Farm has been successful in treating diverse and vulnerable populations for decades. Please see the attachment below including a segment of our demographics for calendar year 2012 (based off of the most recent Management Report numbers).

Inclusiveness of Cultural Competence Plan

Dawn Farm has consistently been awarded a three year accreditation by CARF. As part of this accreditation process, Dawn Farm must seek to identify and reduce barriers to treatment and recovery support services. In order to conform to CARF standards, Dawn Farm has created an Accessibility Policy that ensures no artificial barriers to entry are created by Dawn Farm. Each year the policies and all potential barriers to entry are reviewed by Dawn Farm leadership and Board of Trustees.

Since 1973 Dawn Farm has successfully served a diverse client population. In addition to our staff’s professional training, our clients have taught us invaluable lessons about serving people of diverse ethnic backgrounds, alternative lifestyles, sexual orientations, medical conditions, economic circumstances, and other cultural identities.

Diversity among Dawn Farm’s staff is an important factor in our success. Dawn Farm’s staff consists of men and women of different races, sexual orientations, age, and abilities. We also value maintaining balance of recovering and non-recovering staff. This diversity helps many clients see someone like themselves among our staff, creating a greater sense of safety, understanding, and respect. The presence of recovering staff offers living proof of recovery.

Dawn Farm’s emphasis on recovery-oriented services and recovery management is another key to successfully serving diverse populations. All staff are trained in this model and are expected to use the model for all client interactions. Many of recovery management’s characteristics make it well-suited for addressing the recovery needs of diverse populations: emphasis on broadening the target of interventions to include families and communities; inclusion of indigenous healers and institutions;  the emphasis on expanded menus of recovery support structures; the use of culturally-grounded catalytic metaphors; and the emphasis on partnerships with clients.

Involvement of Persons Served in Planning Projects

Feedback is solicited from clients when we are planning new programs. For example, in the process of developing our new recovery coaching program, we will interview clients to obtain feedback about their perceived needs, what in recovery support would be helpful or unhelpful and the traits of effective coaches. This process is empowering from the client and it is vital for ensuring cultural competence within all projects. Feedback from clients is also sought on a regular basis during residential treatment.  Clients give feedback in three main ways: through verbal comments/discussions, staff notes, and their weekly feedback sheets. Therapists respond daily and weekly to feedback/requests.  

The Compelling Need for Cultural and Linguistic Competence

The rationale to incorporate cultural competence into organizational policy are numerous. The National Center for Cultural Competence has identified six salient reasons for review:

To respond to current and projected demographic changes in the United States.

The make-up of the American population is changing as a result of immigration patterns and significant increases among racially, ethnically, culturally and linguistically diverse populations already residing in the United States. Health care organizations and programs, and federal, state and local governments must implement systemic change in order to meet the health needs of this diverse population.

Data from the 1990 census reveal that the number of persons who speak a language other than English at home rose by 43 percent to 28.3 million. Of these, nearly 45 percent indicate they have trouble speaking English.

The results of a March 1997 survey conducted by the Census Bureau reveal that one in every ten persons in the United States is foreign-born. Currently, the US foreign-born population comprises a larger segment than at any time in the past five decades. This trend is expected to continue.

The Children's Defense Fund predicts that early in the first decade following the year 2000, there will be 5.5 million more Latino children, 2.6 million more African-American children, 1.5 million more children of other races and 6.2 million fewer white, non-Latino children in the United States.

To eliminate long-standing disparities in the health status of people of diverse racial, ethnic and cultural backgrounds.

Nowhere are the divisions of race, ethnicity and culture more sharply drawn than in the health of the people in the United States. Despite recent progress in overall national health, there are continuing disparities in the incidence of illness and death among African Americans, Latino/Hispanic Americans, Native Americans, Asian Americans, Alaskan Natives and Pacific Islanders as compared with the US population as a whole. In recognition of these continuing disparities, the President of the United States has targeted six areas of health status and committed resources to address cancer, cardiovascular disease, infant mortality, diabetes, HIV/AIDS and child and adult immunizations aggressively. (See Health Disparities Among Ethnic and Racial Groups.)

To improve the quality of services and health outcomes.

Despite similarities, fundamental differences among people arise from nationality, ethnicity and culture, as well as from family background and individual experience. These differences affect the health beliefs and behaviors of both patients and providers have of each other.

The delivery of high-quality primary health care that is accessible, effective and cost efficient requires health care practitioners to have a deeper understanding of the socio-cultural background of patients, their families and the environments in which they live. Culturally competent primary health services facilitate clinical encounters with more favorable outcomes, enhance the potential for a more rewarding interpersonal experience and increase the satisfaction the individual receiving health care services.

Critical factors in the provision of culturally competent health care services include understanding of the:

• beliefs, values, traditions and practices of a culture;

• culturally-defined, health-related needs of individuals, families and communities;

• culturally-based belief systems of the etiology of illness and disease and those related to health and healing; and

• attitudes toward seeking help from health care providers.

In making a diagnosis, health care providers must understand the beliefs that shape a person's approach to health and illness. Knowledge of customs and healing traditions are indispensable to the design of treatment and interventions. Health care services must be received and accepted to be successful.

Increasingly, cultural knowledge and understanding are important to personnel responsible for quality assurance programs. In addition, those who design evaluation methodologies for continual program improvement must address hard questions about the relevance of health care interventions. Cultural competence will have to be inextricably linked to the definition of specific health outcomes and to an ongoing system of accountability that is committed to reducing the current health disparities among racial, ethnic and cultural populations.

To meet legislative, regulatory and accreditation mandates.

As both an enforcer of civil rights law and a major purchaser of health care services, the Federal government has a pivotal role in ensuring culturally competent health care services. Title VI of the Civil Rights Act of 1964 mandates that no person in the United States shall, on ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.

Organizations and programs have multiple, competing responsibilities to comply with Federal, state and local regulations for the delivery of health services. The Bureau of Primary Health Care, in its Policy Information Notice 98-23 (8/17/98), acknowledges that: "Health centers serve culturally and linguistically diverse communities and many serve multiple cultures within one center. Although race and ethnicity are often thought to be dominant elements of culture, health centers should embrace a broader definition to include language, gender, socioeconomic status, housing status and regional differences. Organizational behavior, practices, attitudes and policies across all health center functions must respect and respond to the cultural diversity of communities and clients served. Health centers should develop systems that ensure participation of the diverse cultures in their community, including participation of persons with limited English-speaking ability, in programs offered by the health center. Health centers should also hire culturally and linguistically appropriate staff."

The Maternal and Child Health Bureau, through its program efforts related to state accountability and Healthy People Year 2000/2010 Objectives includes an emphasis on cultural competency as an integral component of health service delivery. The National Health Promotion and Disease Prevention Objectives emphasize cultural competence as an integral component of the delivery of health and nutrition services.

State and Federal agencies increasingly rely on private accreditation entities to set standards and monitor compliance with these standards. Both the Joint Commission on the Accreditation of Healthcare Organizations, which accredits hospitals and other health care institutions, and the National Committee for Quality Assurance, which accredits managed care organizations and behavioral health managed care organizations, support standards that require cultural and linguistic competence in health care.

To gain a competitive edge in the market place.

The provision of publicly financed health care services is rapidly being delegated to the private sector. Issues of concern in the current health care environment include the marketing of health services and the cost-effectiveness of health care delivery. The potential for improved services lies in state managed-care contracts that can increase retention and access to care, expand recruitment and increase the satisfaction of individuals seeking health care services.

To reach these outcomes, managed care plans must incorporate culturally competent policies, structures and practices to provide services for people from diverse ethnic, racial, cultural and linguistic backgrounds.

To decrease the likelihood of liability/malpractice claims.

Lack of awareness about cultural differences may result in liability under tort principles in several ways. For example, providers may discover that they are liable for damages as a result of treatment in the absence of informed consent. Also, health care organizations and programs face potential claims that their failure to understand health beliefs, practices and behavior on the part of providers or patients breaches professional standards of care. In some states, failure to follow instructions because they conflict with values and beliefs may raise a presumption of negligence on the part of the provider.

The ability to communicate well with patients has been shown to be effective in reducing the likelihood of malpractice claims. A 1994 study appearing in the journal of the American Medical Association indicates that the patients of physicians who are frequently sued had the most complaints about communication. Physicians who had never been sued were likely to be described as concerned, accessible and willing to communicate. When physicians treat patients with respect, listen to them, give them information and keep communication lines open, therapeutic relationships are enhanced and medical personnel reduce their risk of being sued for malpractice.

Effective communication between providers and patients may be even more challenging when there are cultural and linguistic barriers. Health care organizations and programs must address linguistic competence--insuring for accurate communication of information in languages other than English.

Permission is granted to copy and distribute this Web page (part of the NCCC Policy Brief "Rationale for Cultural Competence in Primary Care") or reproduce excerpts as long as credit is given to the National Center for Cultural Competence.

This Plan reviewed and updated 8/29/23- Ray Dalton