SERVING CONSUMERS FROM A MULTICULTURAL PERSPECTIVE 
Fabricio Balcazar, PhD
University Illinois Chicago
Celestine Willis, M.A.University Illinois Chicago 
Francisco AlvaradoIllinois Division of Rehabilitation Service
Gwenea Jackson-McDaniel Alabama Department of Rehabilitation Service 

Slide 1 Agenda
Cultural Competence Defined, Center for Capacity Building on Minorities with Disabilities Research (CCBMDR) Cultural Competence Model and Validation of CCBMDR Cultural Competence Model and Assessment Survey

Slide 2 Overview of CCBMDR Cultural Competence Trainings
Illinois Division of Rehabilitation Cultural Competence Trainings
Alabama Department of Rehabilitation Service Cultural Competence Training
Questions and Answers

Slide 3 Definition of Cultural Competence
Cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency or among professionals and enable that system, agency or those professions to work effectively in cross-cultural situations.
The word culture is used because it implies the integrated pattern of human behavior that includes thoughts, communications, actions, customs, beliefs, values and institutions of a racial, ethnic, religious or social group. The word competence is used because it implies having the capacity to function effectively. (Cross et al, 1989) 

Slide4 Definition of Cultural Competence cont
The ability to respond respectfully and effectively to people of all cultures in a way that affirms and values cultural differences and protects/preserves the dignity of each individual. (Seattle King County Department of Public Health, 1994)

Slide 5 Cultural Competence
At the individual level, this means an examination of one’s own attitude and values, and the acquisition of the values, knowledge, skills and attributes that will allow an individual to work appropriately in cross cultural situations. 
At a systems, organizational or program level, Cultural competence requires a comprehensive and coordinated plan that includes interventions on levels of: 
policy making; 
infra-structure building; 
program administration and evaluation; 
the delivery of services and enabling supports; and 
the individual. 
(Denboba, MCHB, 1993)

Slide 6 What Does It Mean
When You Become More Culturally Competent?
You develop greater awareness of your own culture, personal identity, strengths and limitations.
You develop greater awareness of the impact of your behaviors and attitudes about others.
You acquire a world view that accepts and appreciates diversity.
You become a better service provider.

Slide 7 CCBMDR Cultural Competence Model
(CCBMDR) Center for Capacity Building on Minorities with Disabilities Research
Fabricio E. Balcazar, Ph.D.
Professor & Director
Center on Capacity Building for Minorities with Disabilities Research
Department of Disability and Human Development
University of Illinois at Chicago

Slide 8 Cultural Competence Models Review
We identified 259 peer reviewed articles and/or book chapters.
Two reviewers examined the abstracts and identified 42 publications that refer to cultural competence models.
After reviewing the full manuscripts, 18 articles representing unique cultural competence models were identified. 

Slide 9  Our Cultural Competence Model
We decided to propose a synthesis model,  developed on the basis of the most common elements identified in the literature review.
Our model initially had 4 main components.
The model assumes willingness of the organization and individual to engage in the process of seeking cultural competence.

Slide 10 Cultural Competence Model
Flow diagram outlining the cultural competency Model. Achieving Culutral Competency is in the center with the variables Practice/ Application, Skills Development, Increased Culutral Knowledge, and Cultural Awarenes poitning towards the center.


Slide 11 Validation
Validation of our Cultural Competence
Model and Assessment Survey
Multiculturalism
Disability
Racism
Race
Ethnicity
Cultural Competence
Oppression

Slide 12 Instrument
Review of literature on cultural competence
Development & selection of instrument items (49)
 25 items from existing scales (CCAG Assessment Tool for Cultural Competence by Arthur, et al., (2005)
(4 items) Cultural Self-Efficacy Scale by Coffman, Shellman & Bernal, (2004) 
(4 items) Gamst et al., (2004)
(3 items) LaFromoise et al., (1991)
(6 items) Goode, (2004) environment checklist (3 items); 
(5 items) Sue, (2001) Multidimensional model of cultural competence 
Review by experts in the field and expert statistician
Pilot testing with occupational therapy clinicians

Slide 13 Sample and Data Analysis
Sample
1,000 randomly generated names of OT professionals
477 respondents from one mailing (47.7%)
Data Analysis (SPSS)

Slide 14 Exploratory and Confirmatory Factor Analysis
Demographic Data Respondents: N= 477

Slide 15 Indices of Fit for All Three Confirmatory Factor Analysis Performed

Slide 16 Cultural Competence Mode
Flow diagram outlining the cultural competency Model. Achieving Cultural Competency is in the center with the variablesOrganizational Support, Criitcal Awareness, and skills development pointing towards the center.
Desire to Engage on the outside

Slide 17 Factor Loadings of the Perceived Cultural Competence 

Slide 18 Factor 1.  Cultural Awareness/Knowledge (a = .76)
Items
I openly discuss with others issues I have in developing multicultural awareness (.67)
I learn about different ethnic cultures through educational methods and/or life experiences (.64)
I examine my own biases related to race and culture that may influence my behavior as a service provider (.63)
I actively strive for an atmosphere that promotes risk-taking and self-exploration (.61)

Slide 19 Factor 1.  Cultural Awareness/Knowledge (a = .76) cont.
Items
I am sensitive to valuing and respecting differences between my cultural background and my clients’ cultural heritage (.59)
I feel that I can learn from my ethnic minority clients (.52)
It is difficult for me to accept that religious beliefs may influence how ethnic minorities respond to illness and disability (.52)
I do not consider the cultural backgrounds of my clients when food is involved (.41)

Slide 20 Factor 2: Organizational Support (a = .81)
Items
Cultural competence is included in my work place’s mission statement, policies, and procedures (.73)
My organization does not provide ongoing training on cultural competence (.72)
My workplace does not support using resources to promote cultural competence (.67)
My work place does not support my participation in cultural celebrations of my clients (.61)

Slide 21 Factor 2: Organizational Support (a = .81) cont
Items
At work, pictures, posters, printed materials and toys reflect the culture and ethnic backgrounds of ethnic minority clients (.60)
I receive feedback from supervisors on how to improve my practice skills with clients from different ethnic minority backgrounds (.57)
The way services are structured in my setting makes it difficult to identify the cultural values of my clients (.51)
I have opportunities to learn culturally responsive behaviors from peers (.50)

Slide 22 Factor 3: Skills Development (a = .81)
Items
I am effective in my verbal communication with clients whose culture is different from mine (.69)
I am effective in my nonverbal communication with clients whose culture is different from mine (.68)
I would find it easy to work competently with ethnic minority clients (.65)
I feel that I have limited experience working with ethnic minority clients (.60)

Slide 23 Factor 3: Skills Development (a = .81) cont
Items
It is difficult to practice skills related to cultural competence  (.60)
I feel confident that I can learn about my clients’ cultural background* (.59)
It is hard adjusting my therapeutic strategies with ethnic minority clients (.56)
I do not feel that I have the skills to provide services to ethnic minority clients (.53)

Slide  24 Figure 1. Measurement Model of Perceived Cultural Competence
(Numbers in parenthesis represent non-adjusted inter-factor correlations)

Slide 25 CCAI Validation: Effects of Social Desirability?
We conducted a sub-study with 223 disability service providers to assess the effects of social desirability on responses to the CCAI
Results indicated no significant relationships between responses to the short form of the Marlowe-Crowne scale (Strahan & Gerbasi, 1972) and the CCAI factors:
Critical Awareness: r=-.15, p=.05
Cultural Skills: r=.13, p=.07
Organizational Support: r=.03, p=.73

Slide 26 Center for Capacity Building on Minorities with Disabilities Research
Cultural Competence Training
Celestine Willis, Director of Education and Training Center for Capacity Building on Minorities with Disabilities Research

Slide 27 Purpose of the Trainings:
To increase awareness of participants and others cultural identity and Ethno-history, attitudes and values about cultural diversity,
To increase participants knowledge of factors that determine cultural differences between African Americans, Latinos and Asian Americans with disabilities,
To help participants identify ways to create a more welcoming environment for consumers from various cultures, and
To help participants plan specific actions to improve services to consumers from different cultures.

Slide 28 Workshop Themes
Examining our own cultural values, knowledge and attitudes
Examining factors that impact cultural diversity:
Visible Disability, Age, Gender, Race, and Appearance
Family and Community Support
Oppression Experience
Knowledge of rights and services
Sense of Entitlement 

Slide 29 Workshop Themes (cont.)
Socio-Economic Level
Religion
Beliefs and Values
Level of Education
Degree of Acculturation
Language and Social Identity
Immigration Status 
Urbanicity 
Planning steps to promote culturally appropriate services and outreach in your agency

Slide 30 Cultural Competence Trainings (Overall)
50 trainings between 2005 and 2009
Trainings conducted in 8 states 
(AL, IL, IN, MI, MN, MO, OH, OR, WI)
Over 1000 staff from 68 organizations participated
Organizations included VR, CBOs, CILs
Training structure and content:
2 hours to 2 days
Lecture, activities, discussions
Goal setting: 
Each organization was invited to set goals to increase some aspect of organizational cultural competence 
We offered up to 6 months of monthly consultation and technical assistance

Slide 31 Curriculum Development
CCBMDR staff work with agencies to customize trainings.
Meeting with key staff to determine needs
Timeframe for trainings
One to two days
CCBMDR staff can provide train the trainer workshops.
Facilitator Manual


Slide 32 Cultural Competence Assessment Instrument (CCAI)
CCBMDR staff administer CCAI per and post via online tool.
CCBMDR staff provide report on individual cultural competence and organizational readiness for change

Slide 33 Center for Capacity Building on Minorities with Disabilities on Minorities Training State of IL 
Francisco Alvarado, Assistant Director 
Illinois Department of Human Services-Division of Rehabilitation Services 

Slide 34 Cultural Competence Trainings (DRS)
Over 300* staff from DRS VR, Home Services, Blind Services and 
Brain Injury CBOs participated 
Training participants elected to participate in the research/evaluation
Individual assessments
233 during the training
54 after the training
Goal setting 
47 offices/organizations
10 2-day trainings
Estimate based on sign in sheets
** 1-day training

Slide 35 Instruments
We collected the following measures:
Satisfaction with training
Cultural Knowledge Assessment
Physical Environment Assessment 
(Moffat & Tung, 2004)
Cultural Competence Assessment Instrument (CCAI-UIC)
(Suarez-Balcazar et al., 2008)
Organizational Readiness for Change
(TCU, 2003)
Follow up data on goal progress and accomplishment 

Slide 36 Satisfaction with Training
Rating of Training	Mean	SD	Range
Ideas and information presented	4.21	.93	1-5
My level of interest in the topic	4.18	1.01	1-5
Opportunity to learn new skills	4.01	1.08	1-5
Application to my work	4.15	1.01	1-5
Met my educational objectives	4.03	1.10	1-5
Average Rating of Training	4.13	.95	1-5
			
Rating of Trainer	Mean	SD	Range
Level of knowledge/expertise	4.69	.66	1-5
Ability to present materials in an interesting manner	4.48	.89	1-5
Ability to present materials in a practical and relevant manner	4.44	.88	1-5
Average Rating of Trainer	4.53	.76	1-5

Slide 37 Cultural Competence Assessment Instrument (CCAI-UIC)
We are in the process of analyzing pre/post comparisons
(1-4 scale, where 1=never, 2=rarely, 3=occasionally and 4=frequently)

Slide 38 Cultural Competence Assessment Instrument (CCAI-UIC)
	Baseline		Post	
	Mean	SD	Mean	SD
Critical Awareness/ Knowledge Seeking	3.10	.29	1.97	.27
Cultural Skills 	2.99	.44	1.97	.30
Organizational Support	2.77	.36	2.22	.34

Slide 39 Organizational Readiness for Change- Staffing
We are in the process of analyzing pre/post comparisons
(1-4 scale, where 1=strongly disagree, 2=disagree, 3=agree and 4=strongly agree)

Slide 40 Organizational Readiness for Change- Staffing
	Baseline		Post	
	Mean	SD	Mean	SD
Staffing	2.61	.41	2.42	.41
Staff Training 	2.80	.40	2.33	.55
Staff Efficacy	3.08	.44	1.86	.45
Staff Adaptability	3.20	.41	2.52	.27

Slide 41 Organizational Readiness for Change- Climate
We are in the process of analyzing pre/post comparisons
(1-4 scale, where 1=strongly disagree, 2=disagree, 3=agree and 4=strongly agree)

Slide 42 Organizational Readiness for Change- Climate
	Baseline		Post	
	Mean	SD	Mean	SD
Climate for Cohesion	2.70	.48	2.52	.30
Climate for Autonomy	2.72	.47	2.58	.19
Climate for Communication	2.68	.53	2.18	.23
Climate for Stress	2.34	.64	2.56	.37
Climate for Change	2.70	.47	2.43	.41
Climate for Leadership	2.62	.48	2.62	.32

Slide 43 Goal Progress Accomplishment within VR Programs
37 VR offices and 10 VR-contracted CBOs contracted for BI participated in follow along telephone interviews
These 47 groups set a total of 98 goals
42 groups (92%) engaged in the follow-along process
Resulted in tracking of 95 goals (97%)
Organizations set from 1 to 3 goals 
(Average: about 2)

Slide 44 Measuring Goal Accomplishment
Types of goals set
Types of facilitators identified 
Types of barriers identified
Levels of goal accomplishment noted during follow-up interviews

Slide 45 Goals Set Example
To improve cultural competence in organizational practices 
(n=68, 68%) 
Infuse cultural understanding into intake processes 
Provide better bilingual/LEP services
Improve cultural elements of the physical environment 
Form a cultural competence committee
Increase the diversity of the workforce
Evaluate/improve the effectiveness of services
Improve outreach and linkages of the organization in the community

Slide 46 Types of Facilitators Identified
People within the organization who provided specific assistance or supported the goal (e.g., staff, management)
Other providers in the community to learn from or partner with (e.g., other social service agencies, churches, universities)
Center for Capacity Building on Minorities with Disabilities Research (e.g., training materials, staff consultation)

Slide 47 Types of Barriers Identified
Lack of bilingual staff
Lack of money
Lack of time
Lack of diversity among staff & management
Reluctance to change among staff & management
Negative community perceptions of organization (e.g., lack of trust in organization)
Federal/State mandates that constrain options for making needed changes

Slide 48 Levels of Goal Accomplishment

Goal Status at Final Follow Up	
#	% of Total Tracked (N=95)
Goal dropped	15	16%
Goal put on hold	18	19%
Active pursuit, no progress	13	13%
Active pursuit, some progress	17	18%
Accomplished less than desired goal	8	8%
Accomplished goal as expected	23	24%
Accomplished more than expected goal	2	2%

Slide 49 Center for Capacity Building on Minorities with Disabilities Research Cultural Competence Training State of Alabama
Gwenea McDaniel, M.A., CRC
Diversity and Recruitment Specialist
Alabama Department of Rehabilitation Services (ADRS)

Slide 50 ADRS
Alabama Department of Rehabilitation Services
Mission Statement
To enable Alabama’s children and adults with disabilities achieve their maximum potential
Vision
The Alabama Department of Rehabilitation Services will promote a respectful, equitable and fair environment for staff; and provide services to consumers that recognize, accept and utilize the skills, knowledge, and abilities of diverse individuals
Values
We value all staff and their contributions in achieving our mission
We value the worth, dignity, and rights of people with disabilities

Slide 51 ADRS Diversity Plan
To have agency leadership committed to formulating a diverse staff
To have a staff that understand the meaning of diversity
To have the diversity of staff reflect the diversity of the general population of the state
To provide culturally competent services

Slide 52 Cultural Competence Trainings
About 741* staff from ADRS VR, CRC, SAIL, and AEIS participated 
Training participants elected to participate in the research/evaluation
Individual assessments
404 prior to the training
15 1-day trainings
06/3- 06/4/09: Montgomery, AL			(79 Participants)
10/19/09: Huntsville, AL			(57 Participants)
10/20/09: Decatur, AL				(56 Participants)
10/21-10/22/09: Anniston, AL 			(87 Participants)
10/27-10/28-10/29/09: Homewood, AL		(144 Participants)
12/4/09: Tuscaloosa, AL  			(47 Participants) 
12/7-12/8/09: Montgomery, AL 	 		(63 Participants)
12/9-12/10/09: Mobile, AL 			(115 Participants)
12/11/09: Dothan, AL  				(37 Participants)
Estimated based on sign in sheets

Slide 53 Instruments
We collected the following measures:
Satisfaction with training
Cultural Competence Assessment Instrument (CCAI-UIC)
(Suarez-Balcazar et al., 2008)
Organizational Readiness for Change
(TCU, 2003)

Slide 54 Satisfaction with Training

Slide 55 Cultural Competence Assessment Instrument
These means only include the October data. The June data is currently being analyzed.
Post Surveys have not yet been administered
(1-6 scale, where 1=strongly disagree, 2= somewhat disagree, 3=disagree, 4= somewhat agree, 5 = agree, and 6 = strongly agree)
	Baseline		Post	
	Mean	SD	Mean	SD
Critical Awareness/ Knowledge Seeking	4.41	.70	n/a	n/a
Cultural Skills 	4.25	.72	n/a	n/a
Organizational Support	3.87	.76	n/a	n/a

Slide 56 Organizational Readiness for Change - Staffing
	Baseline		Post	
	Mean	SD	Mean	SD
Staffing	3.83	.88	n/a	n/a
Staff Training 	4.05	.96	n/a	n/a
Staff Efficacy	4.95	.69	n/a	n/a
Staff Adaptability	4.49	.77	n/a	n/a

Slide 57 Organizational Readiness for Change - Climate
	Baseline		Post	
	Mean	SD	Mean	SD
Climate for Cohesion	3.93	1.11	n/a	n/a
Climate for Autonomy	3.83	1.00	n/a	n/a
Climate for Communication	3.85	1.04	n/a	n/a
Climate for Stress	3.28	1.10	n/a	n/a
Climate for Change	3.81	.89	n/a	n/a
Climate for Leadership	3.89	.96	n/a	n/a

Slide 58 Comments & Questions
Slide 59 Contact Information
For more information on the Center for Capacity Building on Minorities with Disabilities Research Cultural Competence training please contact:
Celestine Willis 
Email: willisc@uic.edu
(312) 413-8993

Slide 60 THANK YOU!
Slide 61 TACE Center: Region IV
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Fax: (404) 541-9002 
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My TACE Portal: TACEsoutheast.org/myportal
Email: tacesoutheast@law.syr.edu

Slide 62 Education Credit: CRCC & CEU
DEADLINE: Tuesday, February 23, 2010
CRCC Credit (2.0)**
Login to MyTACE Portal.
Score 80% or better on Post Test within three attempts.
Submit online CRCC Request Form.  
CEU Credit (0.2) 
Sign Participant List and complete CEU Form (on day of webinar from Site Coordinator, or after webinar login to MyTACE Portal. 
Submit Participant List and CEU form to TACE: Region IV 
by Fax (404) 541-9002.
MyTACE Portal: TACEsoutheast.org/myportal

Slide 63 Disclaimer
This presentation was developed by the 
TACE Center: Region IV ©2010 with funds from the U.S. Department of Education, Rehabilitation Services Administration (RSA) under the priority of Technical Assistance and Continuing Education Projects (TACE) – Grant #H264A080021. However, the contents of this presentation do not necessarily represent the policy of the RSA and you should not assume endorsement by the Federal Government [34 CFR 75.620 (b)]. 

Slide 64 Copyright Information
Copyright © Department of Disability and Human Development University of Illinois at Chicago. Center for Capacity Building for Minorities with Disabilities Research. Project funded by the USA Department of Education. National Institute on Disability and Rehabilitation Research.
Chicago, IL 60608
312-413-8993 312-413-1804 Fax