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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
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
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
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
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.
                                                                                      5
Ken Martinez, Psy.D.   6
Ken Martinez, Psy.D.   7
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.
                                                           8
9
Ken Martinez, Psy.D.
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
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
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.
                                                               12
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.
                                                                       13
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.
                                               14
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.
                                                    15
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.
                                                16
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
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
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
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.
                                                          20
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
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
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
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
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
Ken Martinez, Psy.D.   26
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
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
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
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.
                                             30
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.
                                              31
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
Muchas Gracias




     Ken Martinez, Psy.D.   33
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.
                                                               34

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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. 5
  • 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. 8
  • 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. 12
  • 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. 13
  • 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. 14
  • 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. 15
  • 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. 16
  • 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. 20
  • 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. 30
  • 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. 31
  • 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
  • 33. Muchas Gracias Ken Martinez, Psy.D. 33
  • 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. 34