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Addressing Multiculturalism in Clinical Care
- 1. ADDRESSING MULTICULTURALISM IN CLINICAL CARE Jonathan Fader, PhD Olubukonla (Bukky) Kolawole, PsyD
- 4. Poll – Learning from each other
- 5. Multiculturalism in the U.S.A.
- 17. What makes attending to multiculturalism so daunting?
- 21. Finding the balance between stereotypes & generalizations
- 28. Key question How willing are you to being a game changer?
- 31. HOW DO WE CHANGE OUR PERSPECTIVE AND BEHAVIOR TO BE MORE ATTENTIVE TO MULTICULTURALISM IN OUR PRACTICE? What do we do differently?
Hinweis der Redaktion
- BK and JF Present as questions
- JF
- JF Jonathan and bukky give sandi questions and she enters them in here.
- BK It’s old news that America’s diversity is increasing, with growth of Hispanics at the forefront (43% increase per Census 2010 vs. 2000; 4x growth of entire population which was 10%)-Hispanics (Mexicans, Puertoricans, now make up 16% of U.S. population
- BK Despite our growing diversity, the presence of health care disparities reveal the challenges for multiculturalism in the U.S.A. Bronx Health Reach stated… Bronx Health REACH is a coalition of grass roots community organizations and churches dedicated to eliminating disparities in health care by 2010.
- JF SANDI please reformat. The actors were comprised of 2 men, one black one white; 2 women, one black one white. They had the same insurance, presented with identical symptoms. Another interesting note is that not all of the docs were white.
- JF
- BK Given that a large body of research was continuously documenting disparities, Congress requested that Institute of Medicine conduct a study to assess differences in the kinds and quality of healthcare received by racial and ethnic minorities and non-minorities in the US. After reviewing more than 100 peer-reviewed studies, they found that it exists in different facets of health care, even after adjusting for socioeconomic differences and other healthcare access factors. They deemed it unacceptable due to its association with worst outcomes, i.e. death., Occurs in context of broader historic and current discrimination in many Sources contribute to it include health system, providers, patient and managers
- BK Though present IOM clearly reported that this is supported only by small number of studies and Help-seeking behavior is influenced by cultural norms and preferences. Non-Hispanic White families - pursue formal avenues of support, e.g., mental health services, African American and Latino families are more likely to use informal supports, such as extended family or clergy. Stigma associated with mental health care Individuals or parents may experience guilt or shame about mental illness and therefore avoid or delay accessing services. Cultural mistrust of health professionals due to past history Past experiences of discrimination & racism (Tuskegee studies, Eugenics movement/Bell Curve)
- BK Lack of resources, knowledge or institutional priority for interpretation/translation services; 1 of 5 latino report not seeking care due to language barriers Time pressures that limit physician’s accurate assessment of symptoms of minority patients, especially in face of cultural/language barriers Geographic availability of healthcare institutions- study showing opioid supplies available in 25% of pharmacies in a predominantly non-white neighborhood compared to 75% in white neighborhood
- JF? IOS identified three factors that may be operating outside provider’s awareness. Though based on relevant theories and small body of research, some clear evidence show support for these variables.
- These realities can feel disconcerting to providers given the values that bring us to the health care field, which are often altruistic. We enter into this field because… So it begets the question of how are we reconciling those values given our reality, i.e., the challenges we face with attending effectively to multiculturalism?
- This begets the question- how are we reconciling those values given our reality of health care disparities, a clear indicator of the challenges we face with attending effectively to our multicultural society?
- BK While the effects on clients are likely obvious. We must consider the impact disparities have for us. patient dissatisfaction (creates threat to your job/position) poor engagement or adherence to treatment protocols or premature termination of treatment (threatens our values/pursuit for effectiveness) poorer health outcomes of patients (contributes to growth of problems)
- BK IOM described that “All members of a community are affected by the poor health status of its least healthy members and adeptly illustrated in the quote “infectious disease, for example knows no racial/ethnic or socioeconomic boundaries” Failure for patients to utilize services in cost effective way, i.e., minimal use of preventative services or treatment as prescribed and therefore rely on emergency services, which is most expensive form of treatment
- JF
- JF Belief/value in ethnocentric perspective Naïveté Belief in meritocracy Therefore unfair/unjust to even think about this Lack of knowledge of how to attend to it Inherent difficulty with making change
- JF Our hope is to offer some ideas that will enable you to consider
- JF Is this only relevant to micro level? Do we want to introduce this here? Should CC slide follow here?
- JF Is this only relevant to micro level? Do we want to introduce this here? Should CC slide follow here?
- JF Do we want to add the specific3- 4 domains here- awareness, skills, knowledge and behavior or according to Sue, D- (attitudes/beliefs; knowledge; skills
- JF Need to stress willingness to learn . Explain that many cultural competency programs use racial/ethnic profiles which may actually reinforce stereotypes. Another way to point out the danger in using profiles may be to mention the Bell Curve, 60% fit the “norm” the remaining 40% is split on either side; almost half do not fit the “norm”. Making assumptions based on profiles and statistics prevents seeing the patient as an individual. However, some knowledge of the patient’s culture may be helpful. Refer to following slides
- BK
- BK Cultivating an environment that actively fosters the practice of cultural competence Continuously providing trainings Rewards practice of cultural competence
- BK As providers and support staff are the implementers due to direct service provision, we are the real agents of change. For change to occur, providers and support staff will have to individually prioritize and practice the pursuit of cultural competency otherwise problems will unfortunately remain, regardless of how much institution policies support change
- BK Because a s we all know, regardless of how much institution policies support and promote change, unless we individually and collectively become champions for making change, nothing will happen. as implementation is what counts & creates change!
- BK Even more, how willing are you to being a game changer?
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- JF Make these relevant for mental health audience; add Sue’s comments about non westerner’s perspectives on mental health
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- BK A major benefit that comes with being a game changer is the sense of achievement of living in the path of your values, especially those that brought you into the field. We are hopeful that you will not only experience a generalized increase in your sense of effectiveness as a provider by engaging significantly more clients but also that you would feel the pride that comes with actively being a part of the solution of addressing major social problems of healthcare expenses and racism as a social change maker.