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Culture plays a complex role in the development of health and human service delivery programs the need for the provision of culturally appropriate services is driven by the demographic realities of our nation. Understanding culture and its relationship to service delivery will increase access to services as well as improve the quality of the service outcomes. Research has begun to provide the underpinnings for the development of standards for the delivery of services to diverse populations.
The following Principles are drawn from research material on the role culture plays in providing services to older adults. There is an ethic to culturally competent practice. When professionals practice in a culturally competent way, programs that appropriately serve people of diverse cultures can be developed. Each person must first posses the core fundamental capacities of warmth, empathy and genuineness. To achieve cultural competence, professionals must first have a sense of compassion and respect for people who are culturally different.
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Then, practitioners can learn behaviors that are congruent with cultural competence. Just learning the behavior is not enough. Underlying the behavior must be an attitudinal set of behavior skills and moral responsibility. It is not about the things one does. It is about fundamental attitudes. When a person has an inherent caring, appreciation and respect for others they can display warmth, empathy and genuineness. This then enables them to have culturally congruent behaviors and attitudes.
When these three essentials intersect, practitioners can exemplify cultural competence in a manner that recognizes, values and affirms cultural differences among their clients. It is important to build skills that enhance communication. Be open, honest, respectful, nonjudgmental, and - most of all - willing to listen and learn. Listening and observational skills are essential. Letting people know that you are interested in what they have to say is vital to building trust.
Communication strategies have to capture the attention of your audience. This means not only using the language and dialect of the people you are serving, it means using communication vehicles that are proven to have significant value and use by your target audience. Culturally competent service providers must take into account the full range of factors that influence how any one individual service recipient behaves and communicates. Acculturation is a process that occurs when two distinct cultural groups have continuous first-hand contact, resulting in subsequent changes in the original cultural patterns of either or both groups.
The degree to which acculturation takes place is influenced directly by both the cultural and individual-level differences. Rendering psychological and psychiatric assistance to a diverse population carries with it some special issues as well as those more generally noted in other curricula. Consequently, faculty and clinicians in the mental health and behavioral health fields have been working to include diagnostic and clinical criteria that would assist practitioners in becoming more culturally and linguistically competent. As a result of using the OCF, the clinician provides a narrative summary for each of the following categories:.
Cultural identity of the individual 2. Cultural factors related to the psychosocial environment and levels of functioning 4. Cultural elements of the relationship between the individual and the clinician 5. Overall cultural assessment for diagnosis and care. Cultural identity of the individual.
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For immigrants and ethnic minorities, note separately the degree of involvement with both the culture of origin and the host culture, where applicable. Also note language abilities, use, and preference, including multilingualism. Cultural factors related to the psychosocial environment and levels of functioning. Note culturally relevant interpretations of social stressors, available social supports, and levels of functioning and disability.
These stressors would include those in the local social environment and the role of religion and kin networks in providing emotional, instrumental, and informational support. Cultural elements of the relationship between the individual and the clinician. The formulation concludes with a discussion of how cultural considerations specifically influence comprehensive diagnosis and care. The clinician assesses the first four interrelated sections, which provide information that will have an effect in the fifth section on the differential diagnosis and the treatment plan.
Cultural identity involves a range of variables not only including ethnicity, acculturation and biculturality, and language, but also age, gender, socioeconomic status, sexual orientation, religious and spiritual beliefs, disabilities, political orientation, and health literacy, among other factors.
The third section highlights the importance of the assessment of family and kin systems and religion and spirituality.