Ideas for Treatment Improvement

OCTOBER 2002 • VOLUME 5, ISSUE 10 PLEASE COPY OR POST

Cultural Competence Issues
Northwest Frontier Addiction Technology Transfer Center
3414 Cherry Ave NE, Suite 100 Salem OR 97303 Phone: (503) 373-1322 FAX: (503) 373-7348 A project of Oregon Health & Science University

“Our most basic common link is that we all inhabit this planet. We all breathe the same air. We all cherish our children’s future. And we are all mortal.”
John F. Kennedy (1917-1963)

The following paragraphs will provide definitions for terminology related to culture. Cross, T. (1989) gives the following definitions:

Cultural Knowledge
Familiarization with selected cultural characteristics, history, values, belief systems, and behaviors of the members of another ethnic group

T

Steve Gallon, Ph.D., Project Director Mary Anne Bryan, Editor bryanm@ohsu.edu

Be sure to check out our web page at:

he next three issues of the Addiction Messenger will focus on information regarding cultural competency issues for counselors and treatment organizations. As a substance abuse professional the client population of your agency is probably representative of demographics of our society. Society today is both multi-ethnic and multicultural. You may have questions about your clients’ culture and how you can become more culturally sensitive or how your agency can develop cultural competency. This series of articles will address these questions. Ethnic and cultural disparities exist in many aspects of our society including health care. Culture influences the way clients respond to health care provision and can impact the delivery of those services. In order to better respond to client needs, treatment programs and substance abuse professionals can foster their understanding of diversity and further their appreciation and acknowledgment of the differences in their clientele.

Cultural Awareness
Development of a sensitivity and understanding of another ethnic group. This involves internal changes in attitudes and values and refers to qualities of openness and flexibility in relation to others. Cultural awareness must be supplemented with cultural knowledge.

Cultural Sensitivity
Knowing that cultural differences as well as similarities exist, without assigning values (better or worse, right or wrong) to those cultural differences.

Cultural Competence
A set of congruent behaviors, attitudes and policies in an agency that enable that agency to work effectively in crosscultural situations. “Culture” implies the integrated pattern of human thoughts, communications, actions, customs, beliefs, values, and institutions of a racial, ethnic, religious or social group. “Competence” implies having a capacity to function effectively. Cultural competency emphasizes the idea of effectively operating in different cultural contexts while cultural knowledge, awareness and

http://www.open.org/nfatc

Unifying science, education and services to transform lives

3% Asian .4% . arts. ü Staff that is representative of the population. ü Staff sensitivity to the cultural nuances of the client population. The culturally competent agency should implement cultural compe- Ethnicity The way in which groups of people retain and practice customs. skillful and capable of seeking cultural encounters.4% ID 1. Terry Cross (1989) at the University of Portland.6% 8% . wrote an article titled “The Process of Cultural Competence in the Delivery of Healthcare Services” which describes a new model of cultural competence.2% WA 1.8% Hispanic 4. and social views of their group. beliefs.9% . policy and procedure. Individuals may not feel in their comfort zones but it should not cause division.4% . Cultural Encounter – the process which encourages the counselor to directly engage in face-to-face cultural interactions in order to modify their existing beliefs about a particular group to prevent stereotyping. Ph.6% 5. work and play. created by members of the group living together over generations.5% 3. experiences. values.4% 41. Cultural Skill – ability to conduct a cultural assessment to collect relevant cultural data regarding client’s concerns as well as conducting a culturally-based physical assessment.3% 2.PAGE 2 NFATTC ADDICTION MESSENGER • OCTOBER 2002 interact.5 % 9.. offered by Dr.4% 7. The key points of this model include five constructs of cultural competence: Cultural Awareness – the process of conducting a self-examination of biases of other cultures and an indepth exploration of one’s cultural and professional background.6% African American 3. ü Institutionalize cultural knowledge through the encouragement of the agency’s administration.the motivation to “want to” engage in the process of becoming culturally aware.5% 1.2% 7. ü Adapt the delivery of services to reflect an understanding of cultural diversity through making changes to meet the needs of your clients. institutions.5% . knowledgeable. Sub-Culture A group of people within a larger sociopolitical structure who share cultural characteristics which are distinctive enough to distinguish it from the others. üBe awareness of dynamics when people from different cultures Diversity Patterns in Our Region AK HI Indian/Alaskan 15. values and experiences of the client while encouraging behavioral and attitudinal changes.D. through their language. and ü Representation of the client population in decision making and policy implementation within the agency.1% 7. Another model of cultural competence. ü Treatment services that reflect cultural values and treatment needs of the client population. Campinha-Bacote notes that cultural desire is the pivotal construct of cultural competence that provides the energy source and foundation for the journey towards cultural competency. tence at various levels within the agency. includes cultural destructiveness as the sensitivity do not include this concept. Oregon. Cultural Knowledge – process of seeking cultural information as well as biological variations among specific ethnic groups.9% 1. language. Portland.9% .6% . Characteristics of culturally responsive services include: ü Staff knowledge of the native language of the client. ü Conduct a cultural self-assessment. such as attitude. RN. practice. Cultivating Cultural Competence On an individual level within your agency there are several things that can be done to cultivate cultural competence: ü Value diversity by considering differences as strengths rather than tolerating them.2% Hawaiian/Pacific Islander . Culture A group’s shared conception of reality.1% OR 1. Josepha Campinha-Bacote (2002). Cultural Desire . Models of Cultural Competence A culturally competent model of treatment acknowledges the cultural strengths.

Cultural incapacity – individuals unable to accept or respond to cultural diversity existing in a group. Having the commitment to correct the deficiencies. 2002.net Dean. Washington. Cultural competence – accepting. The Process of Cultural Competence in the Healthcare Services. pp. Dean (2001) titled “The Myth of Cross-Cultural Competence” takes a different view of cultural competence. T. No. Cultural destructiveness – relating to culture in an anti-cultural way through negative relationships with other cultures or attempting to eliminate them. 1.transculturalcare. 2002.C. et al (1989). With “lack of competence” as the focus.aafp. Maryland Transcultural Care (2002). Cultural blindness – those individuals stating they are “color blind” and “don’t see color”. Retrieved September 16. Vol. and how do we develop a focus that includes ourselves as having differences. Rockville. Retrieved September 16. (2001) The Myth of Cross-Cultural Competence Families in Society: The Journal of Contemporary Human Services. G. Cultural Proficiency – engaging in research about cultural variety and differences. The Myth of Cultural Competence? In an article written by Ruth G. Cultural Competence. Please fill out the following information. The definitions are summarized below.NFATTC ADDICTION MESSENGER • OCTOBER 2002 PAGE 3 You Can Receive the Addiction Messenger Via E-Mail ! Do you already receive the AM via mail? You can help us cut printing costs by changing to e-mail. CASSP Technical Assistance Center Improving Patient Care (2000). Next Issue: “Cultural Competence: Agency Awareness” . She suggests that reading about other cultures.org/fpm/20001000/5&cult Center for Substance Abuse Treatment (1999). a different view of practicing across cultures emerges”. appreciating and accommodating cultural differences. Including information for trainings that acknowledges and values differences. and biases that are inevitably active? Dean concludes that people working in cross-cultural situations consider a model in which “maintaining an awareness of one’s lack of competence is the goal rather than the establishment of competence. from World Wide Web: http://www. 623-630 . The author’s main concern is how does a person become competent at something (culture) that is continually changing. Pre-competence – recognizing own deficiencies in cultural awareness and the importance of cultural differences and awareness. 6. Thank you ! Name:_______________________________________________________________________________________ E-Mail Address: (Please print)____________________________________________________________________ Mailing Address: _____________________________________________________________________________ Phone: ______________________________________________________________________________________ lowest level of competency and advanced competence as the highest. Keeping that awareness in our conscience will hopefully limit its impact on our work. copy this page and FAX it back to us at 503-373-7348 You will begin receiving the AM via e-mail only. from World Wide Web: http://www.: Georgetown University Child Development Center. Sources: Cross. Cultural Issues in Substance Abuse Treatment. becoming informed of one’s own cultural baggage and trying to become aware of when it interferes with the ability to understand another’s point of view is helpful but that we must recognize how difficult it is to separate ourselves from our own “cultural baggage”. Ruth. beliefs. 82. D. Towards a Culturally Competent System of Care Vol.

“Evidence-Based Treatment Approaches” “What Works for Offenders?” “Manual-Based Group Skills” “Preparing Clients for Change”. Issues 10-12 Registration Form for Series 8 . You will receive. You may complete as many series as you wish. Four continuing education series are offered each year. and return both to NFATTC with a fee payment of $25 (make checks payable to: NFATTC. complete the pre-test on the reverse side of this page. Issues 4-6 Series 3 includes Vol. Issues 1-3 “Methamphetamine: Myths & Facts” Series 6 includes Vol. We will send you a free copy of the main source of material information. 5. 4. by return mail. Completing a series of three issues will earn you 2 CE hours (or a total of 8 if you do all four series in 2002). please). You must then read the three monthly issues of the Addiction Messenger and the reference material for the series. OR 97303 . 4. 5. student ____ Other (please specify)________________________________ Please indicate your primary work setting. (check one) ____ Criminal justice ____ Educational institution ____ Inpatient facility ____ Outpatient ____ Outreach ____ Private practice ____ Residential facility ____ Student ____ Other (please specify)________________________________________________________________________ Return your pre-test by mail or FAX at (503) 373-7348 Northwest Frontier ATTC 3414 Cherry Ave. 4.NAADAC Approved by reading a series of three Addiction Messengers (AM) If you wish to receive continuing education hours for reading the AM just fill out the registration form below. Salem. “What Is A Woman Sensitive Program?” and “Naltrexone Facts” Series 5 includes Vol. Issues 4-6 “Co-Occurring Disorders” Series 7 includes Vol. but no degree ____ Other (specify)______________________________________ What is your discipline or profession? (check all that apply) ____ Addictions Counseling ____ Other Counseling ____ Education ____ Vocational Rehabilitation ____ Criminal Justice ____ Psychology ____ Social Work/Human Services ____ Physician Assistant ____Medicine: Primary Care ____ Medicine: Psychiatry ____ Medicine: Other ____ Nurse ____ Nurse Practitioner ____ Administration ____ None.“Cultural Competency Issues” Name ______________________________________________________________ Address____________________________________________________________ City/State/Zip_______________________________________________________ Phone ______________________________________________________________ What is your highest degree status? (check one) ____ No high school diploma or equivalent ____ Associate’s degree ____ Master’s degree ____ High school diploma or equivalent ____ Bachelor’s degree ____ Doctoral degree/equivalent ____ Some college. Suite 100. NE. unemployed ____ None. a certificate stating that you have completed 2 Continuing Education hours.2 Continuing Education hours for $25 Earn 2 Continuing Education Hours . Issues 7-9 “Trauma Issues” ______________________________________________________________________________ Series 1 includes Vol. 5. The last issue in the series will have a post-test in it. You will need to complete the post-test (along with a 100 word short essay question regarding your reaction to the material) and return it to the NFATTC. Issues 1-3 Series 2 includes Vol. Issues 7-9 Series 4 includes Vol. 4.

“a” and “c” #8 Josepha Campinha-Bacote notes that the pivotal construct of cultural competence that provides the energy source and foundation for the journey towards cultural competence comes from: a. “a” and “b” e. True False #1 A set of congruent behaviors. cultural knowledge d. does not facilitate the acccuracy of a diagnosis c. 5. c. b. Cultural competence c. sensitivity to cultural nuances of the client population. True False #3 Characteristics of providing culturally responsive services would include: a. cultural sensitivity. 3414 Cherry Ave. attitudes and policies that enable an agency to work effectively in cross-cultural situations defines: a. 3. and cultural skills. None of the above #2 A definition of ethnicity would include the way in which groups of people retain and practice customs. allows the provider to obtain more specific and complete information d. d. agency policies and procedures d. “a” and “b” e. c. 6 or 7 Contact Mary Anne Bryan at (503) 373-1322 ext. cultural encounters b. agency attitudes b. improves the overall communication and clinical interactions between client and provider. c. maintaining an awareness of one’s lack of cultural competence is a goal. none of the above e. Salem. Cultural knowledge d. agency practices c.Pre-Test Series 8 Circle the correct answer for each question #6 Josepha Campinha-Bacote describes a new model of cultural competence that includes only the following: cultural awareness. cultural desire c. none of the above #9 A culturally competent agency should implement cultural competence at various levels such as: a. d. providing services that don’t reflect cultural values. having staff that is representative of the population. Suite 100. does not lead to greater client compliance. b. “a” and “b” e. 224 . OR 97303 FAX: (503) 373-7348 You can still register for continuing education hours for Series 1. b. b. Cultural awareness b. all of the above #5 Cultural competence: a. 4. “a” and “b” e. does not influence the development of a treatment plan. and social views of their group. “The Myth of Cross-Cultural Competence”. Dean’s article. leads to improved diagnosis and treatment plans. NE. all of the above #10 Becoming a culturally sensitive and responsive counselor is best conceptualized as a process. “b” and “c” e. she suggests : a. d. language. that it is difficult to become competent at something (culture) that is continually changing. 2. “b” and “c” Mail or FAX your completed test to NFATTC Northwest Frontier ATTC. Cultural sensitivity e. that people don’t have “cultural bggage”. True False #7 In Ruth G. “a” and “b” #4 Cultural competence: a.

Within this group Steve Gallon.” Josepha Campinha-Bacote. and wellness. Project Director Mary Anne Bryan. according to NCCC. Since today’s society is becoming increasingly both multi-ethnic and multicultural there is a need for everyone to continue their growth of knowledge in this area.org/nfatc Why Is Cultural Competence Needed? The National Center for Cultural Competence (NCCC) at Georgetown University (1999) notes that the incorporation of culturally competent approaches within heath care systems remains a great challenge for many states and communities. religions. Organizations and programs are struggling with how best to respond to the needs of diverse groups.D. The need for Unifying science. includes but is not limited to the following observations: * The perception of illness and disease and their causes varies by culture. Suite 100 Salem OR 97303 Phone: (503) 373-1322 FAX: (503) 373-7348 A project of Oregon Health & Science University “Cultural competence is the process of becoming. cultural competence in health care systems. cultures. not a state of being. T http://www. * Culture influences help seeking behaviors and attitudes toward health care providers.open. even in the smallest cultural group. practices and procedures that support the delivery of culturally competent services. These issues substantiate the need for health care programs to develop policies. genders. ages.D.. A key aspect of becoming culturally competent is to be aware of the great diversity among individuals.. * Individual preferences affect traditional and non-traditional approaches to health care.. ISSUE 11 PLEASE COPY OR POST Cultural Competence: Agency Action Northwest Frontier Addiction Technology Transfer Center 3414 Cherry Ave NE. and * Health care providers from culturally and linguistically diverse groups are underrepresented in the current service delivery system. * Diverse belief systems exist related to health. Ph. To Respond to Current and Projected Demographic Changes in the United States. education and services to transform lives . ethnic backgrounds. Populations include people from different races.edu Be sure to check out our web page at: his issue of the Addiction Messenger focuses on issues that can be important to increasing cultural competence in substance abuse treatment organizations. * Patients must overcome personal experiences of bias within health care systems.Ideas for Treatment Improvement NOVEMBER 2002 • VOLUME 5. Ph. sexual orientations as well as physical and mental abilities. Editor bryanm@ohsu. Data from the 2000 census notes that the number of people who speak a language other than English grew 48% during the previous ten years. The National Center for Cultural Competence has developed and outlined the following six key reasons for the incorporation of cultural competence in organizations: 1. healing.

The NCCC notes that there are a lack of policies. ethnicity. Communicating with clients may be even more challenging when there are cultural and linguistic barriers present. * Culturally-based belief systems related to the etiology of illness and disease and to health and healing. The divisions of race. One’s development is impacted by acculturation (merging of cultures that occurs through prolonged contact) and assimilation (responding to new situations in conformity). or joining relatives in America. among other national efforts. Culturally appropriate treatment services can increase retention and access to care. Currently the foreign-born population of the United States is larger than it has been in the last five decades and the trend is expected to continue. fleeing civil strife. including seeking economic opportunities. and child and adult immunizations. These differences affect beliefs and behaviors related to health issues of both clients and providers. and cultural variations may be marked * Beliefs. A lack of awareness about cultural differences could result in liability. * Cultural competence at both the organizational and individual levels is an ongoing developmental process. Diversity exists within all groups of people. * Culturally-defined. 4. including the policy making. All people have unique personal histories. A cultural competency framework used by NCCC is based on the following beliefs: * There is a defined set of values. Ethnic. escaping religious or ethnic persecution. and * Attitudes towards seeking help from health care providers. To Gain a Competitive Edge In the Market Place. cardiovascular disease. and culture as well as family background and personal experiences. belief systems. To Meet Legislative. * People from the same country may have migrated to the United States for very different reasons. To Improve the Quality of Services and Health Outcomes. Regulatory and Accreditation Mandates. and communication styles. 2.3 million report having trouble speaking English (an increase of 52% since 1990). The Healthy People Year 2000/2010 Objectives. planning procedures and institutional structures in many organizations that support culturally competent practices. HIV/AIDS. diabetes. what may be true for most or some individuals from a particular region or culture may not be true for all the people of that group. Your agency may have clients who have recently immigrated to the United States and others who have been here and still identify with their culture of origin. 6. * Economic status and education can vary greatly among people from the same country. 3. 5. health-related needs of individuals. To Eliminate Long-Standing Disparities in the Health Status of People of Diverse Racial. Six areas of health status have been targeted by the Federal government: cancer. practice and consumer/family levels. To Decrease the Likelihood of Liability/Malpractice Claims. 21. state and local regulations in the delivery of health services. traditions and practices of a culture. includes an emphasis on cultural competency as an integral component of health service delivery. structures and practices within agencies. In other words. principles. Some other questions that contribute to differences within groups include: * People from rural areas may be living a more traditional lifestyle than people who emigrate to the United States from urban areas. Reaching these outcomes can include integrating culturally competent policies. Organizations and programs have . expand recruitment and increase the satisfaction of consumers. families and communities. infant mortality. attitudes and practices inherent in a culturally competent system of care. structures. and Cultural Backgrounds. administrative. Differences among people can stem from nationality. and * Cultural competence must be systematically incorporated at every level of an organization. The provision of culturally competent health care services includes understanding of: Avoid Stereotyping While there are many similarities among people from the same cultural background we also need to be aware of the differences and variabilities that exist within a cultural group. * There are important intra-region and intra-group variations among people from the same country.PAGE 2 NFATTC ADDICTION MESSENGER • NOVEMBER 2002 multiple responsibilities to comply with Federal. values. ethnicity and culture are sharply drawn with regard to health in the United States. This knowledge will lessen the possible creation or reinforcement of a cultural stereotype. There continues to be disparities in the incidence of illness and death among diverse groups.

or do (or avoid) on a regular basis to stay healthy? Tell me about it. home remedies. Next Issue: “Cultural Competence: Counselor Approaches” . Please fill out the following information.NFATTC ADDICTION MESSENGER • NOVEMBER 2002 PAGE 3 You Can Receive the Addiction Messenger Via E-Mail ! Do you already receive the AM via mail? You can help us cut printing costs by changing to e-mail. Discussing client beliefs about the possible causes of an illness and the remedies tried previously can be helpful in developing a treatment plan. or other people who are not doctors on help with your problems? Tell me about it.” Patient Care Special Issue. Rational for Cultural Competence in Primary Health Care. healers. and community resources. “Caring for Diverse Populations: Breaking Down Barriers” The Providers Guide to Quality & Culture (2000). family members. Explanation: What do you think may be the reason you have this problem? What do friends. Treatment: What kinds of medicines. Thank you ! Name:_______________________________________________________________________________________ E-Mail Address: (Please print)____________________________________________________________________ Mailing Address: _____________________________________________________________________________ Phone: ______________________________________________________________________________________ traditional healers. The mnemonic framework “ETHNIC” created by Levin. rather than contradicting them. or other treatments have you tried for this illness? Is there anything you eat. science-based alternatives and other cultural practices. and others Intervention: Determine an intervention with your client that may incorporate alternative treatments. copy this page and FAX it back to us at 503-373-7348 You will begin receiving the AM via e-mail only. family. A summary of questions and issues within the framework include: say about your symptoms? Do you know anyone else who has had or who now has this kind of problem? Have you heard about/ read about/seen it on TV/radio/ newspaper? If clients cannot offer an explanation ask what most concerns them about their problem. It is important to show tolerance of and respect for this issue to fully understand the client and provide appropriate treatment. other health care team members. What kind of treatment are you seeking from me? Source: Levin. Collaboration: Collaborate with the client. Retrieved10/18/02 from World Wide Web: www. friends. only then do we begin to truly individualize care. Negotiate: Try to find options that will be mutually acceptable to you and the client that incorporate the client’s beliefs.msh. et al (2000) is a tool that can be used by care providers who work with clients who use folk or traditional practices to provide culturally competent care. Avoiding Sterotypes.edu/research/ Healers: Have you sought any advice from alternative or folk healers. It is also important to ask whether the strategy developed to assist the client conflicts in some way with personal beliefs and traditional practices. “Appendix: Useful Clinical Interviewing Mnemonics. Traditional Healing Issues Your agency may have some clients who choose to use familiar folk or traditional cultural treatment practices in conjunction with your organization’s treatment strategy. When they are seen as an essential part of treatment planning. drink. The standard for addiction treatment should be inclusive of these cultural considerations. Retrieved 10/21/02 from World Wide Web: http://erc. spirituality. et al (2000).org/ National Center for Cultural Competence (2000). between generations.georgetown.

If a non-African American counselor does not possess a cultural knowledge base..Ideas for Treatment Improvement DECEMBER 2002 • VOLUME 5. Extended families are often referred to as a kinship network. There appears to be a tendency to progress from marijuana to heroin. this issue focuses on four of the largest: African Americans. Project Director Mary Anne Bryan.com Unifying science. For those who do. “It takes a whole village to raise a child” reflects this tradition. Editor bryanm@ohsu. For example.” Josepha Campinha-Bacote. The African proverb. strategies. HIV infection is the fourth leading cause of death in African Americans. The vast majority of African Americans do not engage in substance abuse. challenges. What may be true for most of the individuals from a particular cultural group will probably not be accurate for all. For more detailed information you may order a copy from the National Clearinghouse for Alcohol and Drug Information (NCADI) at (800) 729-6686. While numerous cultural groups are represented in our society. T Steve Gallon. Due to space limitations. ISSUE 12 PLEASE COPY OR POST Cultural Competence: Counselor Approaches African American Northwest Frontier Addiction Technology Transfer Center 3414 Cherry Ave NE. Suite 100 Salem OR 97303 Phone: (503) 373-1322 FAX: (503) 373-7348 A project of Oregon Health & Science University “Recognize differences.. Such families often practice a communal form of child rearing. the ideas that appear in the following paragraphs will inspire creative and culturally sensitive approaches to treatment planning and delivery.D. Social repercussions are serious with an estimated half of African American men in prison serving drugrelated sentences. Health and Social Issues African Americans have higher rates of alcohol related medical problems than their white counterparts even though whites have a higher rate of alcohol use and abuse.D. Ph. Treatment Concerns Issues of trust are the core to service delivery problems. 1999) was used as a major resource for the following information. Stereotyping and institutional racism have profound effects on treatm ent access and com p letion. Negative experiences with welfare and social system s have caused m any of these fam ilies and individuals to be hesitant in providing personal inform ation. Hispanic Americans. It is important to keep in mind that diversity exists within all groups of people. the patterns vary by age with many tending not to begin use until after age 21. and suggestions for developing an effective therapeutic relationship will be addressed. education and services to transform lives . Hopefully.. Questions m ay Be sure to check out our web page at: http://www. American Indian/Alaskan Natives.edu his final article in our cultural competency series will provide information on working with clients from several cultural backgrounds. and Asian American/Pacific Islanders. the discussion is brief and meant to stimulate your thinking.nfattc. but build on similarities. HIV/AIDS disproportionately affect African Americans in general and especially injection drug users. Ph. and will help you develop a treatment plan that is truly sensitive to the individual needs of the client. negative attributions and stereotypes may be perceived and/or influence the interactions with clients. Initially marijuana is one of the most commonly used substances. many women who are heads of households have been categorized as dysfunctional. Approaching each person as unique will facilitate your own flexibility and creativity. General concerns. “Cultural Issues in Substance Abuse Treatment” (Center for Substance Abuse Treatment .

Each has its own beliefs. Examples of proverbs are: “The ruin of a nation begins in the homes of its people” (Ashanti) “He who conceals his disease cannot expect to be cured” (Ethiopia) “Even an ant may harm an elephant” (Zululand) Health and Social Issues The negative health and social consequences that American Indians suffer because of substance abuse are both quantitatively and qualitatively higher than other cultural groups. Situational role modeling and practice have been found to be useful and effective relapse prevention techniques. may not appeal to American Indian clients who Talking Circle The Talking Circle or Talking Stick is a group activity in which group members are seated in a circle.washington. Hispanic women have lower substance abuse rates than their male counterparts.diversityrx. Health problems include: heart disease. The use of counseling.hhs. With regard to gender differences.xculture.georgetown.html DIVERSITYRX http:www. It is important to use a holistic approach that integrates the use of traditional ceremonies. Traditional practices that can be used in treatment for American Indians include: be viewed as prying if an attempt at building trust with your client has not been established. Confrontational methods (even direct eye contact) with this group are both ineffective and potentially damaging. it is important that they not be placed into a large “melting pot”.hslib. Water is poured over the rocks to create steam and prayers are said. diabetes. injuries and death. values and practices in treatment.PAGE 2 abuse inhalants. Cultural Competency Websites DHHS Initiative to Eliminate Racial and Ethnic Disparities in Health http:www. homicide and alcohol-related injuries than any other group. An example would be . The Good Way The Good Way promotes spiritual healing through using traditional culture in interpreting the 12-Step program. cancer. American Indian/Alaskan Native With over 400 American Indian tribes. while effective in the mainstream. As each member receives the stick they have the opportunity to speak freely without fear of rejection or interruption. Church affiliation can be a valuable resource to the client. Some treatment programs develop an Afrocentric approach. Youth frequently Sweat Lodge The Sweat Lodge is a small domeshaped structure with heated rocks in the center and participants sitting in a circle around the edge of the lodge. ceremonies. for whom “binge” drinking is a common pattern.edu/clinical/ethnomed/index. culture the more their use patterns mirror the patterns . Such programs emphasize oneness of spirit between people and nature. Treatment Concerns Using culturally sensitive approaches that incorporate and reinforce traditional lifestyles increases retention rates among Alaskan Natives. Being aware of historic issues surrounding trust is important while establishing a therapeutic relationship with the client.net National Center for Cultural Competence http:www.org Cross Cultural Health Care http:www. Acculturation may play a role in this because the longer women have been in the U. Participation in church activities can improve a person’s recovery and decrease the chance of relapse.Step 2: I believe that a greater spirit can help me to regain my responsibilities and model the life of my forefathers (ancestors).gov ETHNOMED http:www. which combines best practices with an African value system.edu/research/gucdc Hispanic Americans Hispanics tend to use cocaine at higher rates than African Americans and Whites. The main barrier affecting treatment is the lack of social services. The group leader introduces the Talking Stick and passes it around the circle.org Transcultural Care Associates http:www.raceandhealth. psychotherapy and referral to 12-Step programs. and traditions. A culturally competent treatment plan would include contact with immediate and extended family members and collaboration with and referral to community organizations. beliefs. They tend to begin using alcohol and illicit drugs at an earlier age than other cultural groups.S. NFATTC ADDICTION MESSENGER • DECEMBER 2002 often take a long time to disclose personal information about their lives. The purpose of the Sweat Lodge is to bring participants closer to the Creator. Clients living in remote areas often resist leaving their communities to seek treatment. More die from suicide.transculturalcare. African proverbs can be used to enhance treatment through increasing insight and broadening perspectives and thinking styles. Alcohol is the drug most frequently used by American Indians. Women tend to die at higher rates due to alcohol-involved causes than women in other cultural groups.

Substance abuse behaviors may be under reported. Health and Social Issues Hispanic Americans have a higher percentage of AIDS cases related to injection drug use than the general population. This may be a factor in substance abuse predisposition for them. Strategies that appear to decrease powerful family relationships or that blame the parent will not be advantageous to treatment. family member interdependence and self-identity of this group’s youth. Treatment Concerns Hispanic clients will benefit from treatment programs that address the following: * Language. Health and Social Issues Substance abuse problems are on the rise with Asian Americans and Pacific Islanders. role-modeling and practice. Treatment that focuses on a holistic approach which integrates traditional values and beliefs and attends to the development of a continuing care plan that reintegrates the client back into their community will be beneficial to the therapeutic relationship.NFATTC ADDICTION MESSENGER • DECEMBER 2002 PAGE 3 You Can Receive the Addiction Messenger Via E-Mail ! Do you already receive the AM via mail? You can help us cut printing costs by changing to e-mail. cultural and geographic barriers. and development of coping skills can be productive strategies that demonstrate respect and an appreciation for cultural differences. Confrontational approaches used in some programs are degrading to Hispanic clients and are destructive to their self-esteem. * Level of acculturation. copy this page and FAX it back to us at 503-373-7348 You will begin receiving the AM via e-mail only. For those who do use. abuse patterns and the drug of choice vary across subgroups. stressrelated issues and adaptation difficulties for many members of all these cultural groups. gram is usually viewed as a last resort by the family and goes outside of normal acceptable parameters of a culture that prefers to handle problems within the family. Treatment Concerns The diversity of Asian Americans and Pacific Islanders has made providing culturally competent services to this group a complex issue. Seeking assistance from a treatment pro- Sources: Center for Substance Abuse Treatment (1999). Tuberculosis in this group often parallels injection drug use and HIV infection in the community. Please fill out the following information. The relationship between substance abuse and crime has been consistently strong as with other cultural groups. and * Service integration. * Immigration status (legal versus illegal). Treatment interventions that exclude or separate the client from their family may be resisted. It is important for treatment providers to be aware of multiple losses. Cultural Issues in Substance Abuse Treatment. Using interventions such as psycho-education. Maintaining an awareness of culture and developing appropriate treatment approaches are never ending challenges for us and can be consistent sources of satisfaction for both the provider and the client. tend to have a lower prevalence of substance abuse than other cultural groups. Thank you ! Name:_______________________________________________________________________________________ E-Mail Address: (Please print)____________________________________________________________________ Mailing Address: _____________________________________________________________________________ Phone: ______________________________________________________________________________________ of women in the general population. Underutilization of treatment programs by Hispanics can also be linked to lack of bilingual or bicultural staff. It has been noted that adaptation to Western culture has changed the once hierarchical family structure. socioeconomic. Rockville. A client’s personal migratory experience and level of acculturation can add a unique dimension when considering their substance abuse history and appropriate treatment plan. The Hispanic culture values an emphasis on respect and the development of trust in relationships. The acknowledgement of a substance abuse problem often leads to a considerable loss of face and feelings of shame for both the client and their family. Maryland Next Issue: “Treatment Engagement Issues” Asian American/Pacific Islanders Asian Americans and Pacific Islanders .

OR 97303 FAX: (503) 373-7348 You can still register for continuing education hours for Series 1. d. True False #7 In Ruth G. b. improves the overall communication and clinical interactions between client and provider. agency policies and procedures d. language. attitudes and policies that enable an agency to work effectively in cross-cultural situations defines: a. providing services that don’t reflect cultural values. does not influence the development of a treatment plan. “The Myth of Cross-Cultural Competence”. d. agency attitudes b. and cultural skills. and social views of their group. cultural desire c. Suite 100. having staff that is representative of the population. “a” and “b” e. 2. Cultural knowledge d. Cultural awareness b. “b” and “c” e. b. none of the above #9 A culturally competent agency should implement cultural competence at various levels such as: a. does not lead to greater client compliance. 5. b. she suggests : a. Cultural competence c. all of the above #5 Cultural competence: a. “a” and “b” e. “a” and “b” #4 Cultural competence: a.Post-Test Series 8 Circle the correct answer for each question #1 A set of congruent behaviors. 3. NE. does not facilitate the acccuracy of a diagnosis c. Salem. all of the above #10 Is cultural competency a goal of your agency? True False Mail or FAX your completed test to NFATTC Northwest Frontier ATTC. that it is difficult to become competent at something (culture) that is continually changing. that people don’t have “cultural bggage”. “a” and “c” #8 Josepha Campinha-Bacote notes that the pivotal construct of cultural competence that provides the energy source and foundation for the journey towards cultural competence comes from: a. c. 6 or 7 Contact Mary Anne Bryan at (503) 373-1322 ext. cultural knowledge d. 3414 Cherry Ave. “a” and “b” e. Cultural sensitivity e. 224 . agency practices c. True False #3 Characteristics of providing culturally responsive services would include: a. Dean’s article. None of the above #2 A definition of ethnicity would include the way in which groups of people retain and practice customs. maintaining an awareness of one’s lack of cultural competence is a goal. “b” and “c” #6 Josepha Campinha-Bacote describes a new model of cultural competence that includes only the following: cultural awareness. sensitivity to cultural nuances of the client population. leads to improved diagnosis and treatment plans. cultural encounters b. b. d. allows the provider to obtain more specific and complete information d. “a” and “b” e. 4. cultural sensitivity. c. none of the above e. c.

What was your reaction to the concepts presented in Series 8? How did you react to the amount of information provided? How will you use this information? Have you shared this information with co-workers? What information would have liked more detail about? _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ .We are interestted in your reactions to the information provided in Series 8 of the “Addiction Messenger”. approximately100 words. As part of your 2 continuing education hours we request that you write a short response. The following list gives you some suggestions but should not limit your response. regarding Series 8.