Addressing Diversity and Disability: A Discussion on Improving Systems-Level Cultural Competency for National Service Programs Webinar for the National Service Inclusion May 15, 2012 Rooshey Hasnain, Ed.D. University of Illinois at Chicago, Chicago, IL Nicholas V. Montalto, Ph.D. Diversity Dynamics, Cranford, NJ Patience Lehrman, Ph.D. Project Shine, Philadelphia, PA Sean Cariño Student Research Intern, Chicago, IL www.serviceandinclusion.org Toll-free hotline: 888-491-0326 (voice/TTY) National Partnerships Addressing Diversity and Disability: A Discussion on Improving Systems-Level Cultural Competency for National Service Programs Webinar for the National Service Inclusion May 15, 2012 Rooshey Hasnain, Ed.D. University of Illinois at Chicago, Chicago, IL Nicholas V. Montalto, Ph.D. Diversity Dynamics, Cranford, NJ Patience Lehrman, Ph.D. Project Shine, Philadelphia, PA Sean Cariño Student Research Intern, Chicago, IL Something to think about… A refugee with a disability shares his experience A Case Example from Asian Human Services http://www.asianhealthservices.org/handler.php?p=about-videos Why Does Cultural Competency Matter? The Reality Facing People with Disabilities • Many studies highlight disparities and poorer quality-of-life outcomes for immigrants, refugees, and minorities with disabilities • Limited awareness of available care and support options • Limited access to disability/rehabilitation services • Limited availability of culturally and linguistically appropriate services (Taylor-Ritzler et al., 2010; Koehn & Swick, 2006; Beach, 2005; Moffat, 2004) We Continue to Face Several Challenges What systems level approaches can we begin to integrate in our work to address these disparity issues? Project Title: Culturally Competent Access to Human Services Our Proposed Approach to the Solution • To identify what works and conduct a comprehensive review of model practices Project Highlights April 2009: October 2010 - March 2011: Worked in partnership: Established a reader’s panel: Responded to a Request for Proposals issued by the Pennsylvania Developmental Disabilities Council (PDDC) A contract awarded to Diversity Dynamics, a New Jersey-based consulting firm, to conduct a 18-month project in partnership with the University of Illinois at Chicago A project advisory committee was formed to work with the project consultants and the multicultural outreach workgroup Identified 7 outside cultural expectancy experts reviewed the report Our approach was to work with a network of key stakeholders and organizations We are here today to share our findings, model practices/ principles, and recommendations as a result of this collaborative effort Establishment of a Project Advisory Committee • Judy Banks, Deputy Director, Disability Rights Network of Pennsylvania • Amanda Bergson-Shilcock, Director of Intake and Operations, Welcoming Center for New Pennsylvanians • Gene Bianco, Executive Director, Pennsylvania Association of Rehabilitation Facilities • Norman Bristol-Colon, Executive Director, Governor’s Advisory Commission on Latino Affairs • Kevin Burrell, Former Project Officer, Pennsylvania Developmental Disabilities Council • Shamaine Daniels, Staff Attorney, Disability Rights Network of Pennsylvania • Dara DeRoiste, Human Resources Director, Pennsylvania Department of Banking • Graham Mulholland, Executive Director, Pennsylvania Developmental Disabilities Council • Javier Robles, President, ThisAbled • Ronald Sy, Former Executive Director, ASIAC (Formerly AIDS Services in Asian Communities) So, What is Cultural Competency (CC)? - Commonly defined as having the awareness, knowledge, and skills to work effectively with diverse populations - The ability to adapt institutional policies and professional practices to meet the unique needs of client populations In practice, cultural competency is a mechanism that can: - Improve quality of service and outcomes for people from diverse backgrounds - Reduce ethnic and racial disparities What We Know… Much of the research on cultural competency (CC) has focused on theoretical and conceptual models, but not the practical Drawbacks to previous work include: • No universally accepted definition • Guidelines and standards have been developed, but not widely applied in the disability field (e.g., CLAS; Office of Minority Health, 2001) • Most studies focus on provider-level outcomes, rather than at the client or systems level Bottom Line: Cultural competency is difficult for providers and researchers to put into practical use (Price and et al., 2005, Geron, 2002) Key Guiding Question What systems level approaches can we take to help improve access and quality-of-life outcomes for culturally and linguistically diverse individuals with disabilities? Project Spotlight Targeted Populations Newer Cultural and Linguistic Groups • • • • • • • • Asian Indian Chinese Jamaican Korean Liberian Mexican Nigerian Vietnamese http://www.webpagefx.com/images/portfolio/Refugees/01.jpg Study Methods • • • • Extensive literature review Analysis of key elements of culturally competent systems Identification of model programs Conducted: -Structured in person and telephone interviews (n=20) -2 focus groups -Immigrant Organization Survey (n=37) -Disability Provider Survey (n=102) Immigrant Organization Survey The survey included: • 37 organizations that specialize in providing services to minority, immigrant and refugee communities • Questions asking immigrant providers to identify barriers that prevented underserved groups from obtaining mainstream services • Respondents could answer survey questions in one of three ways: -Major problem -Minor problem -No problem Figure 2.1 Percentage of Immigrant Service Professionals who Consider Problem "Major" in Nature 100% 93% 85% 81% 80% 70% 59% 60% 40% 20% 0% Lack of language capacity of Failure of disability providers Lack of client awareness of disability service providers to deliver services in a available services culturally competent manner Lack of client eligibility for federal or state-funded services Discrimination against immigrants Figure 2.3 Extent to which members of clientele or community refrain from seeking services because of cultural values and beliefs 50% 40.7% 40% 33.3% 30% 22.2% 20% 10% 3.7% 0% Great extent Some extent Not at all I don't know Disability Organization Survey This survey included: • 102 organizations that specialize in providing services to individuals with disabilities • Disability providers were asked to: -Discuss their successful and unsuccessful efforts to serve diverse ethnic and racial communities -Provide suggestions for system improvements -Identity different forms of training and areas of technical assistance that would be of “great value” Figure 3.2: Outside Services, Resources, and Policy Initiatives Considered of "Great Value" by Disability Service Providers A. Increasing the pool of qualified bilingual/bicultural job candidates B. Easy access to a reliable and current data source for demographic information about diverse communities in my geographic service area C. Mission and capacity information about grassroots organizations active in specific ethno-cultural communities D. In-depth studies about particular ethno-cultural communities in Pennsylvania related to the work of my organization, e.g. needs or asset assessments E. Establishment of a comprehensive state clearinghouse of information about disabilities and cultural diversity F. Refinements in state data collection to capture information on race, ethnicity, and language preference G. A multilingual hotline staffed by people knowledgeable about immigration and disability services who can refer people to my organization H. Capable grassroots organizations willing to partner with our organization to deliver services to specific ethno-cultural communities I. Funding for cultural brokers, i.e. cultural liaisons, to work within my organization J. Formation of a state leadership council consisting of individuals with disabilities from diverse communities K. Funding for educational programs within ethno-cultural communities to heighten awareness of disability services L. Access to free or low-cost per-diem interpreters M. Access to free or low-cost written translation services N. Participation in group contract for discounted Language Line services O. State certification standards for interpreters and translators to improve the quality of communication between service providers and limited English proficient individuals P. Broadened immigrant eligibility for publicly-funded services Q. Use of more culturally appropriate language by disability service providers in describing their services Criteria for Selecting Model Practices Our Choice of Model Practices was Based on Four Criteria: -Relevance to the needs of ethnic, racial, and cultural/linguistic populations -Ability to make a positive difference in the lives of people -Sustainability -Replicability in other settings Benavides & Hernandez, 2007 Layout of the Report Twenty of these cultural competency model practices are described in the main body of this report; an additional 34 are profiled in Appendix 1. We have included both practices specific to the disability field and those from related fields that may be suggestive of new approaches in disability. Our listing of practices is not meant to be encyclopedic, but merely to be illustrative of each principle. Ten Principles of Cultural and Linguistic Competence Advocacy & Empowerment Research & Evaluation Practice & Service Design Community Collaborations Language & Communication Public Policy & Legal Framework Leadership Recruitment Policy Training & Professional Development Community Outreach 1. Empowerment and Advocacy • The “bottom-up principle” • Important for the people most affected by unsound policies to advocate for social change • Asians and Pacific Islanders with Disabilities of California • Ethno-Racial Disabilities Coalition of Ontario (Canada) • National Ethnic Disability Alliance (Australia) 2. Public Policy & Legal Framework • Good laws and regulations give everyone a fair chance. • California Language Access Law (1973, 2002) – covers every state agency directly involved in providing information or services to the public – requires the use of bilingual staff or qualified interpreters whenever 5% or more of the people served by a local office or facility are Limited English Proficient 3. Leadership • What the “head honcho” says (and does!) matters! – Creation of the New Americans Agenda and Action Plan by Governor Deval Patrick of Massachusetts 4. Recruitment Policy • Get the right people for the job! • Recruit and compensate for CLC •Step by Step (PA) •City of Aurora (IL) •Project Shine 5. Training and Professional Development • CLC challenges are many and ever-changing • Consider using innovative in-service training approaches • Online Peer-learning Networks – The Your Voice Project of DiversityRx • Cultural Brokering Workshops – Institute for Community Inclusion and Center for Capacity Building on Minorities with Disabilities Research (University of Illinois) • Experiential Programs – West Chester State University • Interpreter Training – Center for New North Carolinians 6. Community Outreach • “Seek and ye shall find” • Go where the people are physically, socially, and culturally Promising Approaches – Home Visitation Programs • Migrant Education Program, Chester County Intermediate Unit – Welcome Centers (IL) 7. Language and Communication • An “English only” approach is generally exclusionary. • Use multilingual resources to communicate with LEP individuals Interpreting solutions fall into two broad categories: • In-house approaches: qualified bilingual or multilingual staff (dedicated, dual-role or primary role) • Shared resources: language banks, language line, video interpreting, multilingual I & R hotlines, organizational partnerships 8. Community Collaborations • Partner with qualified grassroots organizations • Why? For cultural insights, language capabilities, community access, and greater efficiency • Some Examples of Effective Partnerships – Stairways Behavioral Health and the Multicultural Resource Center (Erie) – Multicultural Health Brokers Co-op (Edmonton) and a variety of health/disability organizations 9. Practice and Service Design • Return to the drawing boards • Reconsider inherited wisdom • Implement acrossthe-board change •Therapy Program for Immigrant and Refugee Families, Aurora Family Services (Winnipeg, Canada) 10. Research and Evaluation • Few studies have evaluated the effectiveness of CLC initiatives. • Let’s learn from our successes and failures. • The journey is just beginning! • National Center for Cultural Competence, Inventory of Promising Practices – http://nccc.georgetown.edu/resources/publicationstype.html#promising • Systems Change for Greater Cultural Competence (Diversity Dynamics Pennsylvania Study) – http://www.paddc.org/images/stories/pdfs/systems_change_for_greater_cultural_competenc e_in_pa_disability_service_sector.pdf A Model Practice Building partnerships between higher education and immigrant communities for over 25 years… Project SHINE Mission and Work • Project SHINE is an award-winning national immigrant integration imitative that help college students, older adult volunteers, and immigrant elders connect and contribute to their communities. • SHINE builds meaningful campus community partnerships to promote intergenerational engagement between college students, older adult volunteers and immigrants. • SHINE builds the capacity of ECBOS and CBOS to deepen their services in immigrant and refugee communities. Pathways for Promoting Immigrant Integration Project SHINE’s Impact The SHINE Philosophy From Client to Colleague to Community Leader Approach Orientation Community Members as “Clients” Service Provider Role of Agency Agency identifies the needs of the community and provides culturally and linguistically appropriate services. Approach Approach Community Members as Community Members as “Contributors and “Community Leaders” Colleagues” “Authentic” Partner and Colleague Capacity Builder/Supporter Agency seeks and obtains community advice in identifying the community needs. Community needs and goals are identified by community leaders. Agency invites community members to participate in program development, implementation and evaluation. Project design originates with community members. Program is run by community leaders. Approaches Asset-Based Approach • Value team members’ assets • Value elders’ and organization’s assets Team and Partnership Approach • Team-based services at host agency • Partnership across cultures, generations and disciplines AmeriCorps Health Literacy Objectives • Enhance English Language and Health Communication Skills of Immigrant Elders and Refugees • Increase Knowledge of Practices that Promote Healthy Aging for Older Immigrants and Their Families • To Deepen the Existing Health Literacy Project by Focusing on the Role of Families in Promoting Healthy Aging Patient Listening Publication AmeriCorps Volunteers as Bridge Builders • Connecting immigrants and refugees with resources • Serve as health navigators • Promote healthy aging through Health Literacy ESL classes and workshops • Form non-familial relationships with immigrant communities Project SHINE AmeriCorps Health Literacy Volunteer Cohort • • • • • • 50+% are 1st or 2nd generation immigrants From 18 countries Age range between 20 - 75 Speak 25 languages Worked with over 150 community partner sites Over 270 AmeriCorps volunteers Contributed over 90,000 hours of service Definition of Authentic Partnership “A close mutual cooperation between parties having common interests, responsibilities, privileges and power.” (Community Campus Partnership for Health) Best Practices for Building Authentic Partnerships • Joint Commitment to Shared Goals • Acknowledge and Value Mutual Skills and Expertise • Mutual Trust and Respect • Joint Decision Making • Balance of Power • Open, Clear, and Ongoing Communication Best Practices for Recruiting Diverse Volunteers Civic Connectors • Ethnic-based social service agencies • Aging/volunteer networks • Religious Institutions • Community-led Informal Networks • Family Members University Partnership • Community-Based Learning Courses • Student-Leadership Department • Second/Foreign Language Department • Sociology, Anthropology, Gerontology Best Practices for Engaging Diverse Volunteers Understand what drives diverse volunteers and leverage their passions in your outreach. (e.g. Giving Back, Connection and Purpose, Faith, Influencing Young Generations , Preserving Culture, Addressing Community Concerns) Develop a continuum of meaningful volunteer roles that targets volunteers at different stages to meet their changing needs Align organizational practices to meet volunteer needs. (hiring bilingual staff, creating flexible schedule Any Questions? Rooshey Hasnain firstname.lastname@example.org (312) 413-0416 Nicholas V. Montalto email@example.com (201) 320-1669 Patience Lehrman firstname.lastname@example.org (215) 204 -3212 Diversity Dynamics Thank you!