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Cultural Competency for Health Care Providers Chelsea Harris MS-II, Charlotte Reback MD, University of Vermont College of Medicine, Burlington VT 2011 SEARCH Scholars Project “ When you learn something from people, or from a culture, you accept it as a gift, and it is your lifelong commitment to preserve it and build on it ~Yo-Yo Ma Project Goals ” Resources •Verify the existence, availability, and relevance of every listed resource listed in the CVAHEC Cultural Competency Manual METHODS Resources Source material was evaluated and subsequently coded on the following scheme: a. Relevant and current: likely to be used as a primary source when reformatting the document b. Relevant for additional reading: worthy of inclusion as a hyperlink or pop-out box within the main document c. Helpful source to be cited in appendix but not highlighted in the main text d. Less relevant and/or out of date e. Non-existent, not useful, not relevant A summary of each source, based on abstract, introduction and discussion was also included •Add each source to EndNote® to standardize citation format and ensure future availability and reference ease Structure •Develop a standardized template for each chapter to convey population-specific information in a uniform, streamlined, and easily searchable manner •Edit existing content for impartiality and consistent voice •Identify key points to be highlighted in “pop-out boxes” Structure: We took a tiered approach in determining the new organization of the manual. We started with the question “why is cultural competence important?” then narrowed to address “what are the barriers?” and finally included chapters on individual populations. We designed the chapter template to begin with an almanac/demographic portion followed by a more detailed cultural profile Introduction Rewrite • Emphasize the importance of Cultural Competency in the context of health disparities •Address barriers care providers face in treating refugee/immigrant/or minority populations New Chapters • Add chapters on Burmese Refugees and Chinese Immigrants to reflect Vermont’s changing population . Information for chapters on new populations was obtained via a literature search and communication with community members and invested parties Why be Culturally Competent? “Cultural competence is not a panacea that will single-handedly improve health outcomes and eliminate disparities, but a necessary set of skills for physicians who wish to deliver high-quality care to all patients.” The literature is increasingly supporting the idea that, besides being a worthy goal in and of itself, cultural competency is improving health outcomes, and may increasingly have a role in cost saving as well. It is an integral part of any substantial effort to address health care disparities. Structural barriers to Care • Inadequate understanding of patients’ previous health care experience • Practitioner biases • Lack of diversity in health care • Underdeveloped clinic infrastructure • Poor communication Spotlight on Burmese Refugees History: Burma is home to one of the world’s longest running civil wars , and consequently a major refugee crisis Culture: Burma is one of the most ethnically diverse countries in the world; however most refugees in Vermont and the US are Karen Religion: Buddhism, Animism Christianity, Islam: along ethnic lines Diet: rice based, augmented with vegetables and fish paste, “hot” and “cold” foods play a role in health Family: prominent social force; tradition of communal child rearing Education: strong tradition stemming from Buddhist monasteries Health: varies based on individual refugee experience Infectious Disease: Intestinal parasites, Hepatitis B, TB Life Style: Betel Nut, Cigarettes and Alcohol, lead poisoning Family Planning: low education, acceptable as “child spacing” Mental Health: frequent history of trauma, stigmatized Traditional practices: strong history, food plays an integral role Spotlight on Chinese Immigrants History: Asian Americans are the fastest growing demographic in the US, but Chinese immigration has a long history, that impacts cultural norms today Culture: built around the central pillars of honor and respect for family, “saving face” is a major motivator Religion: Buddhism, Taoism, Confucianism, Christianity “Respect for one’s Diet: rice and noodle based, parents is the highest supplemented with fish and vegetables. All foods have yin duty of civil life” or yang properties depending on their energies Family: model for all relationships in Chinese Society Education: highly valued among all socioeconomic levels Health: approached in a holistic manner, focused on harmony Infectious Disease: Hepatitis B, TB Life Style: Cancer, increased chronic illness with acculturation Family Planning: still taboo, but changing norms Mental Health: highly stigmatized, holistic approach Traditional practices: highly developed though most immigrants use both Western and traditional medicine Challenges: As a small state, there is not a lot of Vermont –specific data available Because of limited time frame, structural changes need be appropriate to scope so that the manual remains useable between updates Diverse populations and experiences make generalizations difficult This program is funded by U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA)