7. Cultural Competency
- Knowledge Areas
- Educational Experiences
- Resources/Assessment Tools
Cultural competence is the knowledge, interpersonal skills, and behaviors that enable a system, organization, program, or individual to work effectively cross-culturally by understanding, appreciating, honoring, and respecting cultural differences and similarities within and between cultures. The acquisition of cultural competence is a dynamic, ongoing, developmental process that requires a long-term commitment and is achieved over time.
MCH professionals exhibit cultural competence through their interpersonal interactions and through the design of interventions, programs, and research studies that recognize and address cultural differences. (Adapted from National Center for Cultural Competence, Cultural Competence: Definition and Conceptual Framework).
Through participation in this program, a participant will know:
- The influence of personal biases and assumptions on individual and organizational behavior.
- How cultural, ethnic, and socioeconomic factors influence the access to health care services.
- The impact of culturally competent health care practices on individuals’ access to health services, participation in health promotion and prevention programs, adherence to treatment plans, and overall health outcomes.
Basic. Through participation in this program, a participant will:
- Conduct personal and organizational self-assessments regarding cultural competence.
- Assess strengths of individuals and communities and respond appropriately to their needs based on sensitivity to and respect for their diverse cultural and ethnic backgrounds and socioeconomic status.
- Suggest modifications of health services to meet the specific needs of a group or family, community, and/or population.
Advanced. With more experience and building on the basic skills, MCH leaders will:
- Employ strategies to assure culturally-sensitive public health and health service delivery systems.
- Integrate cultural competency into programs, research, scholarship, and policies.
- Identify of the diverse cultural values and traditions in a community
- Conduct self-assessments to monitor own progress (discusses self-assessments and progress with supervisors)
- Explore Georgetown National Center for Cultural Competence: http://gucchd.georgetown.edu/nccc/.
- Conduct an organizational self-assessment of cultural competence (Assessment of Organizational Cultural Capacity. Developed by the Association of University Centers on Disabilities’ Multicultural Council. Instructions at http://www.aucd.org/councils/multicultural/cult_comp_instruction.htm.)
- Analyze models of service delivery and data collection activities that assure maximum participation or maximum representation of diverse communities in the design, receipt or delivery of health services or in a public health assessment.
- Conduct an interview of a family or patient from a different cultural background
- Assessment of own cultural history and beliefs through the creation of a cultural portfolio. Activities might include research and family interviews.
- Participation in assessments or clinical experiences of families with cultural beliefs different from those of the trainee (ie community health checks)
- Discussion on the impact of culture with others, including people of different backgrounds
- Read literature on the impact of cultural competence
- “The Spirit Catches You and You Fall Down” by Anne Fadiman. (http://www.spiritcatchesyou.com/)
Resources/Assessment Tools – 7. Cultural Competency
The Cultural Competence and Linguistic Competence Policy Assessment (CLCPA) was developed by the National Center for Cultural Competence (NCCC) at the request of the Bureau of Primary Health Care (BPHC), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Service (DHHS) to assist community health centers to advance and sustain cultural and linguistic competence.
1994 Amendments to P.L. 103-230, The Developmental Disabilities Assistance and Bill of Rights Act, Administration on Developmental Disabilities, Administration for Children and Families, U.S. DHHS
Cross T, Bazron B, Dennis K & Issacs M (1989). Towards a Culturally Competent System of Care, Volume 1. Washington, DC: Georgetown University Child Development Center, CASSP Technical Assistance Center
Core masters in public health competency development project, version 1.1. October 2004-June 2005, Education Committee of the Association of Schools of Public Health. (page 12).
- National Center for Cultural Competence—This site includes Definitions, Policy Briefs and Curriculum Enhancement Modules.
- HRSA’s Cultural Competence Web Page—This site highlights approximately 40 HRSA-supported projects on the critical subject of cross-cultural health care.
- National Standards on Culturally and Linguistically Appropriate Services (CLAS)
- Cross Cultural Health Care Studies—This interactive self-study program consists of a series of five tutorials in cultural competence, aimed at familiarizing health care providers with common issues that arise while working with people of diverse cultures. The case studies were developed collaboratively by the seven Pediatric Pulmonary Centers.
- Organizational CC Assessment Tool—This organizational self assessment tool was developed by the Leadership Education in Neurodevelopmental Disabilities (LEND) programs.
- National Standards of Practice for Interpreters in Health Care (PDF)
- Culture-Language Links (WORD)
Inclusion Criteria –
To be considered for initial inclusion in this web site, the materials had to meet several criteria:
- the material needed to focus on one or more of the skills listed for a particular competency
- the material needed to describe either a measurement instrument or theory that could support the creation of such an instrument
- the material had to be publicly available, that is, where the item is not a commercial entity available for purchase
- the material needed either psychometric information about its properties as a measure or, particularly in the case of material found only on the Web, a high degree of face validity
Copyright and Use Issues –
The materials initially described were identified for consideration by MCH interdisciplinary training programs. Many of these materials are copyrighted and thus, may not be copied, distributed, transmitted, or published without the express written permission of the copyright owner. It is the responsibility of each user to ascertain whether materials may be freely used or whether such permission is needed.
Portfolios are collections of information that can be used to evaluate MCH knowledge in action.
Portfolios include materials prepared by a learner to demonstrate learning in response to a plan. There is increasing evidence of the utility of portfolios for assessment of learning and for competency assurance in health care.
For a portfolio to be effective, it should include:
- a learning plan that contains specific goals and objectives
- materials that demonstrate achievement relative to the learning plan
- learner reflections
- learner and faculty evaluations of the material
The ACGME, in its draft Toolbox of Assessment Methods, provides some information about the properties and uses of portfolios for assessment.
Assessment By Clients:
The Mental Hygiene Administration/Maryland Health Partners (MHA/MHP Cultural Competency Advisory Group (CCAG) developed a 52-item scale to assess clients’ perceptions of the Public Mental Health System. Statistical analysis identified four core domains assessed by the instrument:
- “the ability to tune into psycho-social, medical, and spiritual needs,
- the accessibility of services and the willingness to negotiate on priorities for care,
- efforts to reach out to racially diverse communities, and
- the willingness to listen to and respect people in recovery from various cultures.”
While this instrument is still a work in progress, it could be adapted for use by MCH populations.
Arthur, T. E., Reeves, I., Morgan, et al. (2005). Developing a cultural competence assessment tool for people in recovery from racial, ethnic and cultural backgrounds: The journey, challenges, and lessons learned. Psychiatric Rehabilitation Journal. 28(3): 243-50.
The ultimate goal of training in cultural competency is change in the behavior of care providers that is linked to improved patient or client outcomes. This goal is elusive, with most educational research articles reporting on learner satisfaction and performance. Given the state of current research, a review of the recent literature provides several instruments that could be used or adapted for use to assess the MCH leadership competency of cultural competency.
There are several basic approaches to the assessment of cultural competency, including:
- self-assessment of the appropriate knowledge, attitude, and skills by the learner,
- evaluation of the learner through observation or survey by faculty or peer observers, and
- evaluation of the learner or clinic by patients or clients who are the recipients of care.
There are a plethora of measures of multicultural competence that have been developed and revised over the past two decades. Many studies designed to evaluate the reliability and validity of individual measures compare, contrast, and correlate the findings with other such measures. A number of the most frequently cited and compared measures are presented here. Please note – only publicly available measures are considered here.
Assessment Of Learner By Faculty, Peers, Clients Or Self-Assessment:
Cross-cultural Counseling Inventory – Revised
Cross-cultural Counseling Inventory – Revised( CCCI-R) was originally created as an 18-item scale used by learners to rate the behavior of a counselor in a short video of a counseling session. The developers of the instrument suggest that it is best used for providing feedback during training – by faculty, peers, and clients – during simulated or actual counseling sessions, and as a self-assessment tool. This instrument has been cited in more than 75 scientific articles.
Information at: LaFromboise, T. D., Coleman, H. L. K., & Hernandez, A. (1991). Development and factor structure of the Cross-cultural Counseling Inventory â€“ Revised. Professional Psychology: Research and Practice. 22(5): 380-88.
Cultural Competence Assessment
The Cultural Competence Assessment instrument (CCA) is based on a model of cultural competence that describes four domains: cultural awareness, competence, diversity, and sensitivity. This instrument has been tested on a variety of health care workers and has been found to have adequate psychometric properties. The instrument has undergone revisions (from 45 items initially to a current number of 38). The authors suggest that the instrument is potentially useful for assessing awareness, sensitivity, and behavior (two subscales), or for assessing overall cultural competence.
Doorenbos, A. Z., Schim, S. M., Benkert, R., & Borse, N. N. (2005). Psychometric evaluation of the Cultural Competence Assessment Instrument among healthcare providers. Nursing Research. 54(5): 324-31.
Multicultural Counseling Awareness Scale
The Multicultural Counseling Awareness Scale (MCAS) is a 32-item self-report measure that assesses respondents’ knowledge and awareness of multicultural competency. The instrument was developed for use by counselors and has been tested on both professional and trainee populations. Originally created in 1991, the scale has been tested and revised several times, most recently in 2002.
Ponterotto, J. G., Gretchen D., Utsey, S. O., Rieger, B. P., & Austin, R. (2002). Revision of the Multicultural Counseling Awareness Scale. Journal of Multicultural Counseling and Development. 30: 153-80.
Multicultural Awareness-Knowledge-and Skills Survey
The Multicultural Awareness-Knowledge-and Skills Survey (MAKSS-CE-R) is a self-assessment instrument developed in 1990 and revised in 2003. Shortening the scale from 60 items to 33 produced a measure that is both more psychometrically improved and more limited. The researchers suggest that the MAKSS-CE-R could be used as pre-post test to assess the impact of training on learners’ multicultural counseling competence.
Kim, B. S. K., Cartwright, B. Y., Asay, P. A., & Dâ€™Andrea, M. J. (2003). A revision of the Multicultural Awareness, Knowledge, and Skills Survey-Counselor Edition. Measurement and Evaluation in Counseling and Development. 36: 161-80.