Cultural Competency

Introduction

At Optum we believe it is critical for providers to have an understanding of Cultural Competency in order to ensure your members get culturally sensitive and appropriate care.  Therefore, we are pleased to highlight some information and key resources to help you on your journey, including free continuing education e-learning programs available through the Office of Minority Health, U.S. Department of Health & Human Services. (see Resources section below)

Cultural Competency Continuum

Cultural competency may be viewed in terms of a continuous progression of growth, development and change.  It is important both for individuals and organizations to continuously and intentionally work to develop and strengthen competencies in order to provide effective services to diverse populations.  The continuum ranges from potentially damaging and uninformed practices to constructive and professionally recognized practices that facilitate culturally relevant service delivery.

According to the often cited and adapted work of Terry Cross, MSW, there are 5 key points on the continuum:

  1. Cultural destructiveness
  2. Cultural incapacity
  3. Cultural blindness
  4. Cultural pre-competence
  5. Cultural competence

Cultural destructiveness may be described as a point at which individuals refuse to acknowledge the presence or importance of cultural differences in the service delivery process.  Disregard for diverse cultures may be seen in behaviors or policies that are damaging to or destructive to cultures and to the individuals living within that culture.

Cultural incapacity refers to a view in which cultural differences are neither punished nor supported.  It is when the individual ignores differences.  In therapeutic settings this may surface in the form of an overly narrow view of symptoms and associated diagnosis without consideration of cultural factors that may be relevant to the overall understanding of an individual’s health, status, strengths and needs.

Cultural blindness involves a more active belief by an individual or organization that cultural differences are of no importance.  Cultural differences may be noted but being color-blind and culture-blind is considered the desired state.

Cultural pre-competence involves recognition and responsiveness to cultural differences along with efforts to address systemic problems through advocacy.  Pre-competence includes open acknowledgement of the need for cultural competency and active pursuit of current information and training related to diversity.

Cultural competence or proficiency holds culture in high regard.  Here individuals and organizations may engage in research, develop culturally-informed therapeutic approaches and share their learning with others. Advocacy for cultural competence takes plans within the organization and more broadly as part of routine practices.   

Cultural Competency Domains

In addition, the work of D.W. Sue and others identified three domains that are important for clinicians and organizations to consider in the development of a culturally sensitive approach to mental health service delivery:

·         Affective: awareness of attitudes, beliefs or biases

·         Cognitive: relevant knowledge set

·         Behavioral: skills supporting effective services across cultures

G. R. Sodowsky and others contributed a fourth domain to be used in the assessment of cultural competencies:

·         Relationship: understanding power differences in the context of therapy

The cultural competency continuum and domains noted here can be used for assessing where individuals and organizations are in terms of their readiness, preparedness and current level of functioning in the provision of culturally competent services.

Resources:

https://minorityhealth.hhs.gov/  - U. S. Department of Health & Human Services - Office of Minority Health website. Information on Cultural Competency, and links to: Center for Linguistic and Cultural Competency in Health Care, National CLAS Standards, Think Cultural Health website, Continuing Education.

https://www.thinkculturalhealth.hhs.gov/education - U. S. Department of Health & Human Services website. Information on National CLAS Standards, Education including free continuing education e-learning programs, Resources to: Recorded Presentations, Quarterly Newsletters, Case Study Video Units and more.

https://www.nlm.nih.gov/hsrinfo/health_literacy.html - U. S. National Library of Medicine - Health Services Research Information Central website. Health Literacy and Cultural Competence information including: News, Data, Tools and Statistics, Guidelines and Journals, Education, Meetings, Conferences and Webinars, Key Organizations.

https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/CLAS-Toolkit-12-7-16.pdf - pdf from the Centers for Medicare and Medicaid Services (CMS) website.  A Practical Guide to Implementing the National CLAS Standards: for Racial, Ethnic and Linguistic Minorities, People with Disabilities and Sexual and Gender Minorities, December 2016.