Good afternoon everybody and welcome to our broadcast. I'm Stan Stovall your host for today's program Today's topic will be providing care to a diverse population and Dr. Courtney Lightner will be joining us live in the studio now for our viewers with questions We'll be taking your calls and faxes throughout this program There's no need to wait for an official Q&A period Just go right ahead and call or fax them in right now the lines are open right now to call in your question You should dial 1-800-953-2233. If you prefer to fax your question to us, then you should dial 1-410-786-0123 Let me give those numbers to you again for the phone 1-800-953-2233 If you prefer to fax them the number is 1-410-786-0123 Now that all the technical information is out of the way Let's get right on with the program and please welcome Dr. Courtney Lighter to our program Dr. Lighter, good to see you again. Good to see you again. Yes, absolutely. Thank you for joining us. My pleasure Let me tell our audience a little bit about you Dr. Courtney Lighter earned his doctor of nursing degree from Rush University He taught at St. Xavier University before moving to Yale in 1994 In 2003 he became the first recipient of the University of Virginia Professorship in Nursing and is currently teaching and doing research at that university He also consults frequently with private industry and with the federal government to develop higher standards of care for elder adults In 1999 he received nursing's highest honor when he was inducted into the American Academy of Nursing And Dr. Lighter, I understand that you're going to be speaking about delivering care to a diverse population What exactly does that entail? Well, the main focus of my presentation is on cultural competent care stand That means both being aware and responding to the culture of a patient Enabling a provider to give better care Isn't that difficult to do given the fact that there are so many different cultures in our country? It's not a simple task stand, but it is absolutely critical to start I'm going to show a little background piece that provides information about the seven main population categories in the United States Then that should help provide us with somewhat of a framework of reference Okay, and then I understand that what we'll do then is take a look at how to provide culturally competent care for each Not quite. I'll be talking about culture care in broader terms There are just too many different scenarios for me to provide specifics Understanding the concept and the process of culturally competent care is what's most important and what I'd like the viewers to be walk away from this show All right. Thank you, Dr. Leiter. And with that let's move on to providing care to a diverse population During the last century the United States has become increasingly diverse Approximately 30% of the current US population belongs to a racial or ethnic minority group and the US Census Bureau predicts That percentage will rise to 60% within the 95 years leaving non-Hispanic whites comprising only 40% of the US population As this demographic shift occurs it creates a great demand for health care professionals to acquire their knowledge and familiarity Necessary to provide culturally responsive care a Failure to do so may lead to increases in non adherence and widen the racial ethnic health disparities that currently exist There are numerous racial and ethnic groups that exist within the 250 million people that make up the current US population While a great deal of variability exists within these groups, and it is important to avoid stereotyping The federal government divides the population into seven basic categories white Hispanic or Latino black or African-American American Indian or Alaska Native Asian-American native Hawaiian and other Pacific Islander and Multiracial We will now look at each population category Highlighting leading causes of death and projected demographic changes over the next century Current demographic information is taken from the 2000 US Census White Americans are defined as anyone with traceable origins in any of the original peoples of Europe the Middle East or North Africa Currently this group comprises approximately 70% of the US population However by 2060 it will comprise less than 50% The Midwest and Northeast have the greatest concentrations, especially Maine, New Hampshire, Vermont, Iowa North Dakota, West Virginia, Montana, Idaho, Wyoming and Colorado White Americans show a wide range of variability with numerous different ethnic groups with distinct languages dialects and cultures There is also a great deal of socioeconomic and health diversity within this group Although the health status of white Americans is often used as a baseline against which other groups are measured It should be noted that white Americans experience many of the same health problems as other populations Lack of access to health care and lack of health insurance are two major factors contributing to poor health outcomes The 10 leading causes of death for this population are heart disease cancer stroke chronic lower respiratory disease unintentional injuries diabetes influenza and pneumonia Alzheimer's disease nephritis nephrodic syndrome and nephrosis and suicide Hispanics or Latino Americans have traceable origins to the peoples of Cuba Mexico Puerto Rico South or Central America or other Spanish cultures regardless of race The federal government considers race and Hispanic origin to be two separate and distinct concepts Hispanic Americans may be of any race Currently Hispanics represent 12.5 percent of the US population about 35 million individuals By the year 2035 it is predicted that there will be 75 million Hispanics comprising about 20 percent of the US population The greatest concentrations of Hispanics are found in the Southwest states from Texas to California especially New Mexico, California, Texas, Arizona Nevada and Colorado as well as Florida Hispanic cultures vary significantly by country of origin Although they do share aspects such as language Emphasis on extended family and tend to be younger than the white non-Hispanic population Cubans are the exception with a higher proportion of elderly than other Hispanic groups Their health profiles also vary for example Puerto Rican suffer disproportionately from HIV AIDS and infant mortality While Mexican Americans suffer disproportionately from diabetes All groups tend to have the same factors contributing to poor health outcomes Language and cultural barriers lack of access to preventative care and lack of health insurance The 10 leading causes of death for this population are heart disease cancer unintentional injuries stroke Diabetes chronic liver disease and cirrhosis homicide chronic lower respiratory disease pneumonia and influenza and birth defects Blacks or African Americans are people having origins in any of the black racial groups of Africa African Americans constitute approximately 12 percent of the American population or almost 35 million individuals By 2035 there will be more than 50 million African Americans in the US comprising 14.3 percent of the population The African American population is represented throughout the country But the greatest concentrations are found in the Southeast and Mid-Atlantic regions, especially, Louisiana Mississippi Alabama Georgia South Carolina and Maryland The health disparities between African Americans and other racial groups are striking in areas like life expectancy infant mortality and other measures of health status for example in 1999 the average American could expect to live 76.9 years while the average African American could only expect to live 71.4 years Factors contributing to poor health outcomes among African Americans include discrimination cultural barriers and lack of access to health care The 10 leading causes of death for this population are heart disease cancer stroke diabetes unintentional injuries homicide HIV AIDS chronic lower respiratory disease nephritis nephrodic syndrome and nephrosis and septicemia American Indians and Alaskan natives are people having origins in any of the original peoples of North and South America including Central America and who maintain a tribal affiliation or community attachment American Indians and Alaskan natives constitute point nine percent of the US population or approximately 2.5 million individuals By 2065 it is estimated that the American Indians and Alaskan native population will top 5 million individuals and comprise 1.1% of the population The greatest concentrations of American Indians and Alaskan native populations are in the West Southwest and Midwest especially in Alaska Arizona Montana New Mexico Oklahoma and South Dakota There are 569 federally recognized American Indian and Alaskan native tribes Plus an unknown number of tribes that are not federally recognized each tribe has its own culture beliefs and practices American Indians and Alaskan natives have a unique relationship with the federal government due to historic conflict and subsequent treaties Tribes exist as sovereign entities But federally recognized tribes are entitled to health and educational services provided by the US government Though the Indian Health Service or IHS is charged with serving the health needs of these populations Their services are based around a reservation structure Since more than half of American Indians and Alaskan natives do not permanently reside on a reservation They have limited or no access to IHS services Health among this population is generally poorer than other ethnic groups due to cultural barriers geographic isolation inadequate sewage disposal economic factors and suspicion towards traditional spiritual beliefs among other factors The 10 leading causes of death for this population are heart disease cancer unintentional injuries diabetes stroke chronic liver disease and cirrhosis chronic lower respiratory disease suicide influenza and pneumonia and homicide Asian Americans are people having origins in any of the original peoples of the far East Southeast Asia or the Indian subcontinent as of 2000 Asian Americans comprise approximately 3.6 percent of the US population or about 10 million individuals By 2050 that figure will grow to 37.6 million individuals or 9.3 percent of the population Asian American populations are generally concentrated in the western states the northeast and parts of the south The states with the greatest concentration of Asian Americans are Hawaii, California Washington, New Jersey and New York Asian Americans represent a wide variety of languages dialects and cultures that are as different from one another as from non-Asian groups Asian Americans have historically been overlooked due to the myth of the model minority or Neuronius notion that Asian Americans are passive compliant and without problems or needs Unfortunately, the effect of this myth has been a failure to take seriously the very real needs and concerns of this population Asian Americans represent both extremes of socioeconomic and health indices While more than a million Asian Americans live at or below the federal poverty level Asian American women have the highest life expectancy of any ethnic group Asian Americans suffered disproportionately from certain types of cancer tuberculosis and hepatitis B Factors contributing to poor health outcomes for Asian Americans include language and cultural barriers Stigma associated with certain conditions and lack of health insurance The 10 leading causes of death for this population are cancer heart disease stroke unintentional injuries Diabetes influenza pneumonia chronic lower respiratory disease suicide nephritis nephrodic syndrome and nephrosis and septicemia Native Hawaiian and other Pacific Islanders are people having origins in any of the original peoples of Hawaii Guam Samoa or other Pacific Islands this group comprises point one percent of the US population or almost 400,000 individuals Until 2000 this group was considered part of the Asian American group in studies of race and ethnicity For this reason there are no population growth projections for this group Native Hawaiian and other Pacific Islanders live throughout the US But their populations are most concentrated in the western mainland states and Hawaii Native Hawaiian and other Pacific Islanders generally experience poor health in the American population as a whole They are more at risk for developing and dying from cancer heart disease diabetes and other diseases Factors that contribute to these poor health outcomes include cultural barriers limited access to health care and poor nutrition and lifestyle The 10 leading causes of death for this population are heart disease cancer stroke chronic lower respiratory disease unintentional injuries Diabetes influenza and pneumonia Alzheimer's disease nephritis nephrodic syndrome and nephrosis and septicemia Multiracial Americans are those people who belong to two or more other federally designated racial categories Approximately 6.8 million Americans or 2.4 percent of the US population Self-identify with two or more racial categories no growth projections have been made the highest concentrations of multiracial Americans live in Alaska California, Hawaii and Washington Census 2000 was the first US census that allowed individuals to self-identify with more than one racial and ethnic category It is very difficult to make generalizations about the health of this group as little research has been done in the coming years As more data is collected a clearer picture of the health status of multiracial Americans will emerge Obviously living in a proverbial melting pot here in the United States We're back alive in the studio now and we have Dr. Courtney Lighter with us to answer our viewer questions before we get there Let's remind you though about phone numbers that you'll need to know to call in with your questions If you want to phone it in you should dial 1<PHONE_NUMBER> if you prefer to fact your question to us The number you should dial is one four one zero seven eight six zero one two three again The numbers to call it in one eight hundred nine five three two two three three to fax it in one four one zero seven eight six Zero one two three Dr. Lighter our first question that has come in and it says basically based on your presentation Which we just saw it appears that there are many health disparities among the elderly Does access to health care play a major role in such health disparities? Disparities in health refer to the differences between two or more population groups in health outcomes and in the prevalence Incidents or burden of disease? disability or injury or even death Disparities in health care refer to the differences between two or more population groups in health care access coverage and quality of care including the differences in preventive diagnostic and treatment services Disparities in health care also contribute to disparities in health Likewise studies have found that factors such as discrimination bias language barriers and preferences about health care practices Contribute greatly to the disparities in health care However, no single factor contributes more to disparities in health and health care than the access to health care Whatever viewers called in and felt that it was absolutely amazing that these health disparities even exist in this country Can you give us a little more information on that? I'll tell you the Institute of Medicine did a landmark report called unequal treatment confronting racial and ethnic disparities in care Which provides a compelling evidence that racial and ethnic disparities persist in medical care for a number of health conditions and services These disparities exist even when comparing individuals of similar income and insurance levels Hence whether you're have a low social economic status or a high it really didn't matter so there is evidence of racial and ethnic disparities amongst patients with comparable insurance and the same illness has been the Most troubling since health insurance coverage is widely considered to be the great equalizer in our health care system The momentum to address health care disparities has grown largely in response to the step taken by the US Department of Health and Human Services in 1999 which established a national goal of limiting health disparities by the end of this decade Dr. Letter we have a question that was faxed into us and it reads as follows How much do we know about health disparities in non-white populations? Well, although evidence of racial and ethnic health disparities is substantial The evidence base for developing interventions to eliminate these disparities is unfortunately quite limited for example One of the most controversial conclusions that the IOM report on unequal treatment was that provider bias hence doctors and nurses Biases and stereotypical beliefs may actually play a role in clinical decision-making hence They are making decisions on rather to do provide a certain level of care based on The stereotypes that we have of a particular population More precise information about the role of biases and other potential causes of disparities Will help when making decisions about how to allocate our resources to eliminate those very disparities that exist Increasing the knowledge base will require obviously routinely collection of analyzing data on health care use across racial and ethnic groups Data from national surveys health insurers and different health settings is also needed to better understand The problems and the impact of intervention on those various ethnic and racial groups The lack of data on racial and ethnic minority groups other than African-Americans is a major cause for concern One reason we know so little about patterns of health care use for example in American Indians Alaska Natives Asian Pacific Islanders and Latinos is that we have not taken the time to collect the data or have Insufficient sample sizes in available data sources So baseline and follow-up data course racial and ethnic groups is essential for monitoring our purposes. All right, Dr. Ledger, thank you very much and that's all the questions we have from our viewers right now So why don't we go back to your presentation? The concepts of race culture and ethnicity are often used synonymously However, each concept has a very different meaning. There is no one definition that describes the meaning of race Thus the term could be defined as a distinct populations of humans Distinguished in some way from other humans The most widely used methods of defining races are those based on skin color facial features ancestry and national origin Many social scientists argue that most racial definitions are fairly imprecise arbitrary derived from customs and very between cultures Hence defining human beings based on race is more related to sociopolitical constructs rather than science The US Office of Management and Budget responding to criticisms revises standards for classifying federal data on race and ethnicity In fact in the new standard set five categories for data on race including American Indian or Alaska native Asian black or African American native Hawaiian or Pacific Islander and white a separate designation for data on ethnicity includes two categories Hispanic or Latino and Not Hispanic or Latino The federal statute notes that racial and ethnic categories set forth in the standard should not be interpreted as being primarily Biological or genetic in reference Race and ethnicity may be thought of in terms of social and cultural characteristics as well as ancestry Culture can be defined in multiple ways in general most definitions encompass socially inherited beliefs Practices habits customs and rituals Culture can transcend generations the only unifying theme in defining culture is that culture is actually learned Thus much of what we believe think and act is due in large part to culture Hence once culture can profoundly determine what is perceived as health versus what is perceived as illness Ethnicity is usually defined as a membership of a person to a particular Cultural group usually ethnic groups have a sense of shared common origins distinct history or collective cultural Individuality it is possible for people to share the same ethnic group yet have very different nationalities When we look at cultural competence Hence that should be the goal of health care professionals is to have cultural competence in providing care for their patients or residents Thus cultural competence refers to providing health care that is sensitive to the needs and health status of the different population or groups Since patients may have different views of culturally responsive care It is essential for health care providers to ascertain as much information About the patient's beliefs prior to developing a culturally appropriate treatment plan Thus addressing the following aspects of patients belief may yield invaluable information to provide more culturally responsive care What is the patient's beliefs related to health and illness? Hence is the traditional methods of maintaining and restoring health What are their views on home remedies health resources that may be accessible to that population or to that patient? What are the traditional pharmacies? Hence? What are they taking to cure or to prevent diseases or illness? Do they use traditional healers? What is their belief surrounding death and dying and what is their beliefs around decision-making? Who makes the decision for that particular patient or resident? What is their view related to technology? Can technology be used as a as a means of helping to to cure them or to care for them? When we look at the environment, are there certain things in the environment that is appropriate or inappropriate? Should we have more than one or two chairs in the room because in their culture they have multiple visitors So how does the environment affect how they are cared for? Also, what is their expectation of health of the health care system and its practitioners? In addition to ascertaining information from the patient that may lead to providing culturally responsive care The health care providers should consider both their verbal and non-verbal skills that may either facilitate communication with the patient or not Health care providers should ask the following questions What are my own cultural values and beliefs and biases because we all have biases and values? Have I obtained sufficient information about the cultures that I am serving? What is my level of language proficiency of the patient populations that I am serving? What is the level of English proficiency for the patients in which I serve? Am I respectful of my patients hence personal space and body language? Am I using a lot of medical jargon or slang that may be misinterpreted by the populations in which I'm serving? Am I using enough open-ended questions? Have I provided reading materials that demonstrate a respect for the patients and language and cultures that I am serving? All right, we are live again here in the studio with Dr. Courtney Lider and as a reminder to all of you who have questions for us today Let me give you the phone numbers if you'd like to call in your question You should dial 1-800-953-2233 if you prefer to fact your question to us Then you should dial 1-410-786-0123 those numbers again for the phone 1-800-953-2233 for the facts 1-410-786-0123 Dr. Lider, it's question time again. I'm glad to hear it's then there's a lot to take in here So I'm glad to have the chance to clarify a little more for our viewers. Okay Well, our first question is this which agencies in the United States Department of Health and Human Services have Offices or programs that focus on racial and ethnic minority health? Well, actually there are several federal agencies that do focus on ethnic and racial minority health as well as their Disparities the first one is the Office of Minority Health as a wishes a part of the US Department of Health and Human Services The next website is the Health Resources and Services Administration and another source is the Indian Health Services website All three are listed on the screen. Okay next question Where can I find statistics about minorities and cardiovascular disease? Fact sheets from the American Heart Association The second website is actually the Centers for Disease Control and Prevention Which is a part in the section of the National Center for Health statistics will be another great website Both of these websites are now listed on the screen. Okay, that's all the questions We have from our viewing audience. I guess we can get right to the next round, right? Thanks, then I guess that means it's time for the next segment. So I agree with you Okay, well, let's move on. We'll take the next part of the presentation by Dr. Courtney Lider Dr. Camfina Bacote model for cultural competence serves as a wonderful model for health care providers to examine their own cultural competence Dr. Camfina Bacote model for cultural competence is often cited in the literature in this model The health care provider is continuously assessing and striving to achieve the ability and Availability to effectively work within the cultural context of the client or patient or resident in this model Health care providers continuously work towards cultural competence by addressing five constructs cultural awareness cultural knowledge cultural skill cultural encounters and cultural desire The process of cultural awareness occurs when the health care provider is able to examine their own values biases and stereotypes Cultural awareness also requires the health care provider to examine the potential cultural biases or Racisms that may exist within the health care system for example if every single picture that is Given to the individual or to the resident or the client has white Americans but yet the population that is predominantly visiting that setting is black That would be a problem within the environment The process of cultural knowledge occurs when the health care provider educates themselves About the worldviews of other cultures and or ethnic groups in which they wish to encounter Moreover it involves learning how disease processes and management may vary dependent on the cultural or ethnic group Cultural skills occurs when the health care provider can conduct a relevant cultural assessment Hence cultural skill is achieved when the cultural data are used to develop and implement a culturally relevant treatment plan Cultural encounters is a process that encourages the health care provider to actually engage directly in the patients from different ethnic or cultural backgrounds in order to modify Existing beliefs about a cultural group and to prevent potential stereotyping Finally cultural desire addresses the motivation of the health care provider to truly acquire new knowledge about the different cultures cultural desire is truly an intrinsic level not imposed by Internal or external regulatory bodies, but truly says that is what the health care provider Wants to learn so cultural desire is when there is an intrinsic level by the health care provider To understand and to learn about the culture. It is not imposed by an internal or external regulatory agency in this model is truly an Interactional dynamic model for cultural competence requires that all five constructs be obtained in achieving cultural competency is an ongoing dynamic process it never ever ends thus The health care providers should examine their cultural competence on a regular basis to assist with a continuous appraisal of cultural competence the Aquanim asked based on the Kambahini-Baccato model of cultural competence was developed The cultural competency health care delivery model says a stands for awareness Am I aware of my biases and prejudices towards other cultural groups as well as racism in the health care systems that I operate? The S stands for skill. Do I have the skill to conduct a cultural assessment? The K stands for knowledge Am I knowledgeable about the world views of different cultural and ethnic groups as well as having knowledge in the field of Bicultural ecology The E stands for encounters Do I seek out face-to-face and other types of interactions with individuals who are different from me? The D stands for desire. Do I really want to become culturally competent? We're back in the studio now live with our next question session and as a reminder to all of you who do have questions You can call them into us by dialing 1-800-953-2233 If you prefer to fact your question to us, then you should dial 1-410-786-0123 Again for the phone 1-800-953-2233 for the facts 1-410-786-0123 All right, Dr. Leiter our first question now. Where can I find more statistics about minorities and cancer? Well, there's several wonderful websites that deal specifically with minorities that may have cancer The first website is the American Cancer Society's fact sheet on minorities Another website you can refer to is the National Cancer Institute Again, both websites are now listed on the screen. Okay, our next faxed question Where can I find statistics about minorities and substance abuse? Absolutely, probably one of the best resources for this topic would be the substance abuse and mental health services Administration and yet again refer to the website at the bottom of your screen. All right, Dr. Leiter Thank you very much all the time. We have her questions right now that we've gotten to so far But we have one more segment. Why don't you set this last segment up for us? That's right, Stan I'd like to talk a little bit about the critical domains of cultural competence that were identified by the health resources service Administration. All righty, let's take a look The US Health Resources Services Administration or HRSA Attempted to identify the critical domains of cultural competence for health care providers and organizations HRSA convened a panel of researchers to critically appraise the published literature on cultural competency This panel then identified key domains for providers and organizations These domains include value and attitudes cultural sensitivity communication policies and procedures trading and development facility characteristics intervention and treatment models The following is a condensed iteration of HRSA's domains for the health care provider and organizations to achieve cultural competence Domain one value and attitudes The beliefs and mindsets of an organizations and professionals and consumers influences Directly the care encounters that a patient may actually receive therefore The provider's delivery of care and the way in which consumers perceive care may be very different These values can manifest themselves as different levels at the individual level the importance of acknowledging and respecting the other cultures and The role of culture in health care is essential One particular topic area of emphasis is that of the provider diversity Beyond the individual consumer and provider the importance of incorporating principles related to cultural competence for the organization missions Visions and goals is critical Awareness and acceptance of culture and its impact on how care is delivered and received is an essential element in a culturally competent program and applies to both consumers as well as providers Culture can affect and influence the perception of a health problem and the severity of the problem and whether to seek advice Thus providers who are aware of culture beliefs also have more effective communication with their patients Awareness and acceptance can take various forms from acknowledgement to respect Identification and recognition of the differences between cultures and how they shape interactions Represents a first step towards accommodating and adapting care to respect those differences Ultimately conveying respect during encounters where differences of values exist remains challenging because manifestations of respect depend on culturally specific norms of interaction Furthermore the impact of cultural value differences is not limited to race and ethnicity Alone but extends to socio-economic status and power dynamics that differ by race and ethnicity At an organizational level the importance of creating mission and vision statements that articulate and organizations principles and rationale related to providing culturally competent health care services is essential These goals and objectives can also manifest themselves in program announcements policies and requests for proposals In domain 2, which is cultural sensitivity Cultural sensitivity generally refers to heightened awareness of a culture Hence cultural sensitivity relates to understanding a consumer's beliefs values and practices within a cultural context and awareness of how a provider's background may influence professional practice Cultural sensitivity also refers to some of the less readily quantifiable aspects of care with regard to culture those non-verbal communication visual representation and non-translated culturally sensitive materials are examples that may interfere with communication and lead to being culturally insensitive in Domain 3, which is communication Communication encompasses a wide range of activities that describe the flow and exchange of information Amongst those involved in the provision and the recipients of care This focuses primarily on the interpersonal to exchanges between the consumer the patient and the individual providers and the Exchange that occurs between consumers and the health care delivery organizations This follows the U.S. Office of Minority Health cultural and linguistically standards that were enacted to correct the inequalities that exist in the provision of health services Consumers and providers each possess independent styles of communicating There is evidence that having a sufficient number of administrative and provider staff competent in negotiating the communication styles of racial and ethnic groups seeking services can actually help minimize the need for interpreters and other language services Open communication between the provider and consumer and the consumers family is also critical to gaining understanding between the providers and consumers with different communication styles in Domain 4 policies and procedures Policy development can occur in planning and governance as well as creating provider incentives and grievances and conflict resolution processes Defining the breadth of plan and provider networks and staffing also becomes relevant in a managed care setting a precursor of policy development is a process to incorporate cultural competence language on policy statements including strategic plans and contract requirements Caution should be exercised in policy development as this can serve as a barrier to care Agencies or professionals that are culturally blind may believe that they are implementing Culturally competent policies and procedures when their policies may actually discriminate against different racial and ethnic groups and restrict access to services In domain 5 training and staff development Training and staff development refers to the ways in which provider organizations can develop cultural competence amongst healthcare providers And other staff involved in the provision of care Articles discuss the importance of training providers in culturally and linguistically appropriate communication and identify measures and Standards to ensure that this type of training as well as training in cultural knowledge occurs At its heart the objective of training is that providers will reach a state of cultural knowledge and develop cultural skills Cultural knowledge means that the healthcare provider begins to show familiarity with the broad differences the similarities and the Inequalities in experiences beliefs and values and practices that may vary among various groupings within their society that they serve To reach this stage of familiarity and competence with other cultures the provider must be able to identify and have the ability to understand the cultural world view and Theoretical conceptual frameworks of patients from different cultures at this level the provider has developed the skill set to access and Individuals background and formulate a treatment plan that may be culturally relevant in domain 6 Facility characteristics and capacity and infrastructure Providers should seek to provide services that are accessible to many different cultures in a location and environment That is accessible and supported by information systems that can track cultural data Accessibility extends to the physical environment in which care is provided and how it is culturally perceived In domain 7 intervention and treatment model features the interventions and treatment model features range from culturally and linguistically competent evaluations Diagnosis treatment and referral services to interactions with traditional healing beliefs and inclusive decision-making in Other treatment model features that influence whether consumers and providers interact in a culturally competent manner include care coordination and health benefits in Conclusion providing culturally responsive care is a challenge for most healthcare providers However, given the increasing patient diversity is imperative that health care providers achieve cultural competencies in the populations that they serve as Healthcare providers remain aware to the potential variability that exists within and between racial and ethnic populations Will potentially minimize negative stereotyping The ascertainment of cultural competence is an ongoing process for all health care providers However, the use of the Campina-Baccotti model of cultural competence and HRSA's critical domains of cultural competence are two methods for beginning the process of improving one's cultural competence Further the incorporation of the class standards for cultural competence cannot only improve the health care provider's cultural competence But the health care organization To this end when care is provided in a culturally responsive manner This serves as a positive strategy for tackling the growing diversity within the US population. Thank you We are back in the studio now live for a final question session and the wrap-up of our broadcast as a reminder If you do have a question and we are running out of time if you'd like to phone it in you should dial 1-800-953-2233 if you prefer to fact your question to us you should dial 1-410-786-0123 Those numbers again to phone it in 1-800-953-2233 for the phone. That's for the phone for the facts It's 1-410-786-0123 our first facts question for this session Where can I find more statistics about minorities and diabetes? well, there are several places and probably the most important website for Diabetes and understanding some information about a minority health with diabetes is probably the American Diabetes Association And you can refer to that website also at the bottom of your screen. Okay, doctor You know no matter what race what culture we are we have probably all felt at one time or another that we Weren't paid the attention. We didn't get the time That we felt was deserving to us I'm a little curious about the studies that were done when you're trying to identify inequities in health care delivery Diversities in health care.  Well, that's an excellent question stand and there are multiple methods that researchers can use to try to get an understanding or or or to attempt to Step in into the shoes of the health care provider in some of the studies that that I reviewed in preparation for our discussion today They use multiple methods. They did surveys for example and getting opinions of health care providers They also did something what what we would call trained models that would go into the doctor's office or go into the hospital and Based on the trained model or trained patient they would follow a script and they would be then be observed ie the health care provider would be observed and They would Repeat the script over and over and over but this time using different ethnic Patients although they're still following the same script But then we could observe that in fact the physicians the nurses the hospital administration would treat actually those patients of Different races and ethnic backgrounds quite differently the type of questions that they would ask those trained models the the recommendations for follow-up was Magnificantly different when compared to the and this is not meant to to to sound harsh the classic Middle-age white male that would go in and give the exact same History and story as perhaps the black person or the Asian person seeing the same doctor So but yet but yet got better care got more attention spent more time with the patient would have you that's correct And that is what's quite troubling because one of the other studies that that I reviewed talked about that if you ask health care providers in Surveys do you perceive that the care that you provide an Asian or or native Hawaiian is any different than you may? care for a Caucasian Elder and Almost unanimously everyone says of course not. I'm a doctor. I'm a nurse. I am all patients you exactly I'm colorblind, but then when you Confront them with the data that actually it's almost like this in inherent intrinsic Thing that just comes over that in fact the cure and the interventions are in fact different.  That's incredible You know you touched on the issue of language barriers in your presentation I was curious about another issue that that is serious here in America the one of illiteracy people who literally can't read no Matter what their cultural or ethnic background or persuasion is as far as the health care delivery to those people I think that language is so important and you know to think that we are living in a melting pot for most of The country that language remains probably The largest barrier to providing excellent health care to our patients I think that the assumption that health care providers may have that People who may have a different ethnic background or racial background Understand at the same level as people who may be native-born to the country is a huge barrier and can actually Harm our patients or our clients So we must be very cognizant that not because the patient is coming to the health care system and may speak or Have certain language skills. They may not have the skills required to follow through on intervention So we must be cognizant about that. You know Dr. Letter seems So remarkable. There are so many medical advances technological advances that are just really taking off becoming almost space-age like But yet the the interpersonal communication between human beings the person-to-person Contacting what have you it seems that it's still lacking in a lot of different areas And that is having an impact on health care in this country, isn't it that is absolutely correct? And that's why hopefully if we can learn from some of the models that I discuss We can begin to bridge the gap to really listen to what our patients are saying Don't have some of those interesting biases that all blacks do this or all or all whites do that Exactly across the board absolutely, but the more that we can listen and not just jump to to Assumptions is the better off for our patients and for our practices that we will actually be all right We have another fax question here, and it reads as follows Are there any other additional resources that you can provide to our health providers out there when addressing? patients of different races cultures or ethnicity ethnicities excuse me absolutely There is a wonderful publication This call is entitled closing the gap and it's a newsletter that comes from the Office of Minority Health Each issue is devoted to a specific health topic of concern to minority communities To be placed on this mailing list for upcoming issues simply call the Resource Center at the Office of Minority Health and the number is 1-800-444-6472 It's an excellent resource to all health care professionals interested in increasing their knowledge about issues concerning minority health. I Can't stress enough that the more health care providers increase their sensitivity and awareness to the unique potential Differences in the populations we serve will help to increase our ability to better serve our diverse populations All right, Dr. Lighter. Thank you very much and it seems that's the last of the questions We have from our viewing audience and that concludes our broadcast for today our many Thanks to Dr. Courtney Lighter for being with us today and sharing that very important presentation And to each and every one of you who called in with your questions And remember you can see this entire broadcast for up to one full year from this date at CMS.internetstreaming.com and for duplication purposes you can contact the National Technical Information Services They're located at 5285 Port Royal Road room 1008 Sills Building Springfield, Virginia the zip code 212 excuse me 2216 1 again That's 2216 1 and their phone number you see it there on the screen 1 703 05 6186 and be sure to join us for our next broadcast It's scheduled for July 29th when Dr. David Cazarette will be here to talk with us about end-of-life and hospice issues We want to thank you very much for watching until next time. I'm Stan Stovall