AORTIC DISSECTION and management of aortic dissection
Cultural competence pdf
1. Speaking of Disparities, did you
know that?…
Racial/ethnic groups
Have less access to, and availability of, mental health
services
Are less likely to receive needed mental health services
Often receive poorer quality mental health treatment
Are underrepresented in mental health research
African Americans have higher death rates
than Whites for 12 of the 15 leading causes of
death
2. Did you also know that?…
Hispanic/Latino and African American children
are less likely to receive specialty mental health
care as opposed to white children
Suicide is the second leading cause of death for
American Indian and Alaska Native youth in the
15-24 age group, 2.5x the national average
82% of youth charged in adult courts are youth
from racial/ethnic groups
3. And…
Hispanic/Latina and Asian American female teens
have the highest rates of depression
Children of Color are over-represented in the JJ
and Child Welfare systems and for the most part
under-represented in the community based mental
health system
Reducing disparities for ethnic/racial groups
would have saved $229.4 billion in 2003-2006
Eliminating disparities for racial/ethnic groups
would have reduced indirect costs associated
with illness and premature death by more than $1
trillion between 2003 and 2006
4. Safe Schools/Healthy Students
Strategic Planning for Sustainability
Ken Martinez, Psy.D.
Technical Assistance Partnership
American Institutes for Research
Washington, D.C. / Corrales, New Mexico
May 18-19, 2011
5. The Color of America
is Changing Even More
in 2011_____________
White (Non-Hispanic) 196.8 million 63.7% + 1%
Latino/Hispanic 50.5 million 16.0% +43%
African American 38.9 million 12.6% +12%
Asian American 14.6 million 4.8% +43%
American Indian/
Alaska Native 2.9 million .9% +18.4
Native Hawaiian
and other Pacific
Islander .5 million .2% +35.4
Other race 19.1 million 6.2% +24.4
Bi/Multi-racial 9.0 million 2.9%__ +32.0_
People of Color >135.4 million/308.7 43%
(Not counting all other ethnic groups) (US Census Bureau, 2011)
Ken Martinez, Psy.D.
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8. Projected Rate of Increase of Youth of
Color in US from 1995-2015
American Indian/Alaska Native +17%
African American +19%
Hispanic/Latino +59%
Asian American, Native Hawaiian
and other Pacific Islanders +74%
Caucasian/White - 3%
Ken Martinez, Psy.D.
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10. What is Cultural and Linguistic
Competence (CLC)?
Cultural competence is a set of
congruent behaviors, attitudes,
and policies that come
together in a system, agency,
or amongst professionals and
enables that system, agency,
or those professionals to work
effectively in cross-cultural
situations. (Cross, et al., 1989)
It is about “respect” and
ultimately, about eliminating
disparities and
disproportionalities
Ken Martinez, Psy.D.
10
11. Examples of what CLC is…
Vision, mission, logic modeling,
and strategic planning that is
aligned and reflects commitment &
action to CLC values, practices and
outcomes at all levels -
A safe organizational climate based
on trust and mutual respect
Individual and organizational self-
assessment which leads to
individual and organizational
change that addresses challenges
Sufficient resources (human and
financial) to reflect the leadership’s
commitment to infuse CLC into
practice and sustain it over time
Ken Martinez, Psy.D.
11
12. Examples of what CLC is…
Administration, management
and staff mirroring the
population(s) served
proportionately – Adult role
modeling/Practicing what we preach
Policies and procedures that
operationalize CLC in daily work
(organizational structure, planning, design,
budgeting, P&P, implementation, evaluation)
Contracts with providers,
agencies, community partners,
etc. that include specific
contractual expectations about
CLC with incentives/penalties
Ken Martinez, Psy.D.
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13. Examples of what CLC is…
Administrative and staff performance appraisals that include
CLC performance measures that are directly linked to salary
increases and promotions
A receptive organizational environment that promotes
addressing race, ethnicity, class, disability, privilege, power,
gender, sexual orientation, historical trauma, spirituality and
other psychosociocultural issues relevant to the school,
community and staff
A CQI process (productive use of data) that is directed to
eliminating disparities in access, availability, quality and
outcomes for un-served/underserved student populations
Ken Martinez, Psy.D.
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14. Examples of what CLC is not…
A “color-blind” philosophy and approach
An “add on” or “overlay” or “just another
(unfunded) government requirement”
Limited to ethnic/racial groups
Just a translated brochure
Just literature with faces of children of
different colors
Just serving ethnic food or playing ethnic
music in class or at trainings/gatherings
Ken Martinez, Psy.D.
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15. Examples of what CLC is not…
Choosing a youth of color to make a
presentation because s/he is a youth of color
Asking a receptionist or maintenance worker
to interpret
Having a person of color on an advisory
board as the token representative of the
diverse community
Assuming that a staff member of color is
culturally or linguistically competent –
stereotyping and unfairly placing burden on
him/her
Assigning all work associated with CLC to
one individual – relieving everyone else of
ownership, reducing likelihood of system
infusion which undermines sustainability
Ken Martinez, Psy.D.
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16. Examples of what CLC is not…
Collecting demographics on
ethnic/racial populations and not using
the data to address and eliminate
disparities – cost and burden vs. value
Stereotyping individuals because they
belong to an ethnic/racial group, lower
SES group or underserved population
(LGBTQI2-S), based upon our limited
and sometimes incorrect knowledge of
that group
Ignoring “youth culture”
“Western benevolence” – we know what
is best for you! (cultural deprivation/
disadvantaged model)
Ken Martinez, Psy.D.
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17. Besides Doing the
“Right Thing”
What is the Ultimate Goal of
Cultural and Linguistic
Competence?….
Eliminating/Reducing Disparities
Eliminating/Reducing
Disproportionalities
Improving access, availability,
quality/appropriateness,
accountability, affordability,
utilization and outcomes
Ken Martinez, Psy.D. 17
18. Definitions
Disproportionality refers to a situation in which a
particular racial/ethnic group of children is represented in
child welfare, juvenile justice, mental health or other child
serving systems at a higher percentage than other
racial/ethnic groups and the general population.
Over/Under-representation - the difference between how
children/ youth are represented
Disparity refers to disparate or inequitable treatment (how
the individual is treated) or services (types, access,
availability, utilization, affordability, quality, appropriateness,
quantity) provided to children/youth from ethnic/racial
groups and their outcomes as compared to those provided
to similarly situated White children/youth.
Adapted from Race Matters Consortium, 2001
19. Causes of Disparities
Institutional
○ Laws, policies and practices
○ Structural/Institutional racism
Social Determinants
○ Socio-economics, education, employment, housing,
transportation
○ Geography / physical environments
○ Biology
○ Access to/availability/affordability/utilization/quality of services
○ Individual discrimination/prejudice by race, gender, or class
○ Social or environmental stressors / support
○ Court/agency culture
Cultural Differences
○ World view
○ Historical trauma - issues of trust
○ Health/wellness/illness/curative beliefs
○ Language, values, beliefs, traditions, practices and rituals
20. Disparities and Disproportionalities of Children
of Color
“Do your homework” - learn about what
D & D exists in your schools/communities
Over-representation in juvenile justice/
child welfare/special education
Under-representation in prevention
activities, mentoring programs and
community based services/supports
Develop strategies to reduce/
eliminate/increase accordingly
That is all great, but HOW do we do this?
Ken Martinez, Psy.D.
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21. Data, Data, Data…
Did I say Data?
If you don’t identify it, it won’t get counted
If you don’t count it, it won’t get measured
If you don’t measure it, it won’t be in the budget
If it isn’t in the budget, nothing will happen!
Ken Martinez, Psy.D. 21
22. Steps to Gathering and Using Data
Get baseline data – collect only what you need
Value vs. Burden
Use available Federal, state, county, local, agency sources
Begin with census data and projections, American
Community Survey http://www.census.gov/acs/www/
General data points to review
Ethnicity, race, income, language preferences/ spoken,
length of residency, acculturation, generation in US
Agency data to review
Ethnic/racial percentage/proportion at various points in the
systems (child welfare, juvenile justice, special education,
other)
“Mine the data” – Dig deeper
Ken Martinez, Psy.D. 22
23. Systems Data from Juvenile Justice -
Proportionately by Race/Ethnicity
Type of alleged offense
Time of alleged offense
Location of alleged offense
Rates of arrest
Rates of, and lengths of stay in, detention/long-
term placement
Type of prosecutorial and judicial decisions at
disposition
Diversion rates
Alternative service rates
Availability/quality of services/supports in lock-up
Ken Martinez, Psy.D. 23
24. Systems Data from Mental Health -
Proportionately by Race/Ethnicity
Rates of inpatient/residential care
Rates of outpatient/community based
care
Rates of preventive activities/programs
Rates of access, availability, utilization,
affordability, appropriateness, quality
and outcomes of services/supports
Ken Martinez, Psy.D. 24
25. Systems Data from Schools –
Proportionately by Race/Ethnicity
Rates of expulsions
Rates and lengths of in/out of school detention
Rates and lengths of suspensions
Reasons for expulsions/suspensions/detentions
Rates of special education placements by type
Rates of gifted program placements
Rates of IEPs
Rates of referrals for mental health/substance
abuse services/supports
Rates of referrals to police/juvenile authorities
Ken Martinez, Psy.D. 25
27. Steps to Gathering and Using Data
Develop community needs
assessment to specifically identify
individual/community needs through
an inclusive participatory action
research process
Attempt to
Set up data systems uniformly across
agencies
Collect data uniformly for comparison
purposes
Set up data systems to be able to
disaggregate/stratify data
Mine the data (again)
Ken Martinez, Psy.D. 27
28. Community Example
A case of disproportionalities – Special Ed and JJ
Used data to track every referral – to deal with the
elephant(s) in the room
Analyzed demographics
Student Climate Survey and clinical data
Outcomes
Parent Advisory Board
Parent University
Student Advisory Committee
Staff development/training
Study sessions
Family involvement is crucial
Engagement of all partners “authentically”
Mined the data – dug deeper, disaggregated/stratified data
Continuous quality improvement processes
Ken Martinez, Psy.D. 28
29. What does this have to do with me?
Engage all partners authentically
It is all about the community and what it needs
If you don’t ask the hard questions (confront the
elephant), no significant change will happen
Data driven planning and implementation
promotes sustainability
Don’t be satisfied with just what you see, dig
deeper
Focusing on one or more of the disparities or
disproportionalities can make a significant
contribution to community
Ken Martinez, Psy.D. 29
30. How do we become good stewards in our
communities and focus on sustainability?
Leadership with vision
Political will
Commitment and resolve
Shared ownership
Dedicated resources
Meaningful and authentic
partnership and
collaboration with
community
Ken Martinez, Psy.D.
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31. How do we become good stewards in our
communities and focus on sustainability?
Collecting and using
data smartly and
strategically – dig
deeper again
CQI process directed at
eliminating disparities
and addressing
domains
Accountability to our
community
Training/technical
assistance
Ken Martinez, Psy.D.
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32. Safe Schools/Healthy Students
What have you done to promote and
infuse CLC by eliminating/ reducing
disparities/ disproportionalities in
your communities?
Are you using data wisely
(addressing the elephants in your
room)?
What are your outcomes?
What are your challenges?
How have you met those
challenges?
What do you need to succeed and
sustain? Ken Martinez, Psy.D.
32
34. References
Cross, T., Bazron, B., Dennis, K., and Isaacs, M. Toward
a Culturally Competent System of Care, Volume 1.
Washington, D.C.: Georgetown University. (1989.)
U.S. Census Bureau
http://www.census.gov/prod/cen2010/briefs/c2010br-
02.pdf
Ken Martinez, Psy.D.
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