Steffany Stevens: Good afternoon. My name is Steffany Stevens, and I am a member of the Southeast TACE Region IV team and want to welcome back many of you that have participated in many of our previous sessions and a big, hearty welcome for those of you who are joining us for the first time. As most of you already know, the mission of the Southeast TACE Region IV center, as well as our other nine counterparts across the country, is to work together and work together to improve the quality and effectiveness of vocational rehabilitation services. The primary purpose is to enhance employment outcomes for individuals with disabilities. Our TACE works in the eight southern Southeastern states. We have the largest region to serve and are very proud of that and we are working with some great people. As you know we serve Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina and Tennessee. Our TACE is a collaboration with the DBTAC, the Southeast ADA Center. Both the DBTAC and the Southeast ADA Center are managed by the Burton Blatt Institute. Just a quick note about the webinar system, we are using a system that is fully accessible to everyone regardless of their disability and/or the assistive technology that might be used with a computer. This allows us to conduct workshops over the computer. This system makes it possible for us to conduct workshops over the internet from just about any computer with internet connection and web browser. Please note that sometimes when you dial into the number, long distance charges may apply. Unfortunately, there are many computer issues that you have reported to us that are inherent to your systems and are beyond our control. That is why it is important for you to check your systems prior to the session. Staff is available upon request to work with you in advance of the sessions.
As part of our today's session,-[Audio interference] if you have questions, you can type them in the chat area. Our speakers will follow up with these questions at the end of the webinar. For those of you joining us on the telephone line that will not be able to see what is in the chat room, all of that will be voiced so it can be captured. Now, I will go ahead and introduce our speakers. At this point, we are ready to begin. We are so privileged to be joined by our featured speakers and we have four for this webinar. We have Fabricio Balcazar. Dr. Balcazar is a professor in the Department of Disability of Human Development at the University of Illinois at Chicago. His primary interest is in developing methods for enhancing and facilitating consumer empowerment and personal effectiveness of individuals with disabilities. Celestine Willis is the Director of Education in Training for the Center on Capacity Building for Minorities with Disabilities Research in the Department of Human Development at the University of Illinois at Chicago. She co-developed CCBMDR's cultural competence training curriculum and model with Drs. Fabricio Balcazar and Yolanda Suaraz Balcazar. Our next presenter is Gwenea Jackson McDaniel and Gwenea McDaniel is currently the Diversity and Recruitment Specialist for the Alabama Department of Rehabilitation Services where she has almost 20 years of experience in capacities as a rehabilitation counselor, unit fields supervisor and rehabilitation specialist. And our last presenter is Francisco Alvarado. Dr. Alvarado is the Assistant Director for the Illinois Department of Human Services Division of Rehabilitation Services where he has over 20 years experience and expertise working in areas of vocational rehabilitation center. I would like to give a welcome to everyone and thank our presenters today and I’m going to turn it over to our first presenter, which is Celestine Willis.
Celestine: Thank you, so much, Steffany and I would like to welcome everyone as well and say good morning or good afternoon, depending on where you are joining us from. I'd like to start out first, by saying that the four of us are very honored to participate in this webinar and have followed very closely the good work that the Southeast TACE center has been doing and we are very privileged to be working with them on it. We want to give you a little background on our center. We are the Center for Capacity Building for Minorities with Disabilities Research in the Department of Disabilities and Human Development at the University of Illinois at Chicago. Our center’s main goal is to increase the capacity of community-based organizations like centers for independent living, and other agencies in the state vocational rehabilitation to document the impact of their programs and develop cultural and competence services. The center utilizes a participatory research methodology to promote organizational teams. Our mission is to promote positive rehabilitation outcomes for minority individuals with disabilities at the national level. As the center’s staff conducts participatory research and demonstration projects in collaboration with interested agencies engaging in active dissemination efforts and providing state of the art training and technical assistance on cultural competency to professionals and researchers in the field. Today, we will be focusing on the use of cultural competence training as a strategy to enhance the skills of individuals in organizations that are serving a growing population of individuals with disabilities from diverse backgrounds. We will introduce our conceptual framework developed and conducted cultural competence training by our staff here at the University of Illinois at Chicago and we are going to be, Our hour training aims to build critical awareness that impacts cultural diversity. Next slide, please.
So, our agenda today is, first we are going to try to define social competence for you. We are going to talk about the Center for Capacity Building for Minorities with Disabilities Research, our social competence model and validation of the model and give you an overview of what our trainings look like, what a person in an agency can expect from us, how we work with agencies. My friend, Francisco Alvarado, from Illinois here, is going to talk a little bit about the collaboration that we had with the Illinois division of Rehab Services and then Gwenea McDaniel will talk about the work that we did with them in Alabama and, hopefully, we’ll be able to answer some of your questions. Next slide please.
Now, there is no definitive definition of cultural confidence. Others in 1989 developed this particular definition of cultural competency. In the 20-something years since then, most definitions have used this framework. Cultural competence is a set of congruent behaviors, attitudes and policies that come together in a system, agency or among professionals and enable that agency to work effectively across cultural situation. So in other words, you have to have behaviors, attitudes and policies that all come together, that work towards helping individuals and professionals work towards effective cultural competency. So they use the word "culture," because it implies the integrative pattern of human behavior that includes thoughts, communications, how we act, our customs, what we believe in, our values and the institution of racial, ethnic, religious or social groups. The word competence is used because it implies having the capacity to function appropriately. Let me start there, and say that it implies having the capacity to function effectively. Now when you hear the word cultural competency, you assume that at some point you are going to reach a level of competency and now you are completely competent in social competence. Now that is not the case. Social competence is an ongoing, developmental process and we’ll talk more about that later. But, it does imply that you have immersed yourself into gathering the knowledge necessary to function effectively with others. Next slide, please.
So, continuing with that, we also pulled a definition from the Seattle King County Department of Public Health. And they said the ability to respond respectfully and effectively to people of all cultures in a way that affirms and values cultural differences and protects and preserves the dignity of each individual. When we’re doing our training, we encourage the groups that we work with to develop their own definition of cultural competence. Look at some of the definitions that we provide them and see whether or not they’re gaps in them, things that do not necessarily speak to what it is that they are doing at their particular agency and to develop their own definition of cultural competency. Next slide, please.
So at an individual level, this means that we need to examine our own attitudes and values and we need to have the skills and attributes that will allow us to work appropriately in cross-cultural situations. Now, we all have biases. Before we can start trying to address any other culture, we have to understand our own culture and understand our own biases. Any assistance, organizational or program level, cultural competence requires these five things: policy making. It needs to have the policies that speak to cultural competency. There needs to be something in your policy, your rules, your regulations that says you are going to treat people in a culturally competent way, you are going to serve them, rather, in a culturally competent way. With infrastructure building, you need to be able to put resources behind this. Cultural competency does not happen in a vacuum. You need to have the resources in order to be able to support the work that you are doing. Program administration and evaluation: Your program administration must be done in a culturally competent way. You must be able to evaluate and do self assessments of yourself and of the organization, in the delivery of services in enabling support, in every individual. Cultural competency looks at these on an individual level, as well as on an organizational or program level. Next slide, please.
What does it mean when you become more culturally competent? You develop greater awareness of your own culture, your own personal identity, your strengths and your limitations. You develop a greater awareness of the impacts of your behaviors and attitudes about others. You acquire world views that accept and appreciate diversity. You become a better service provider and I believe you become a better human being. When I started this work some years ago, I felt that I was fairly competent, culturally. But as I have begun my journey, I have discovered many things about myself and the world that I've lived in that has enabled me, I believe, to work even more effectively with people. So, I think this journey that you are about to start, is going to be one that is going to provide you with much, much wonderful expressions and experiences along the way as you open your eyes and heart and mind to what is around us. Next slide please.
What I am going to do now, is I am going to turn this over to Fabricio Balcazar. Fabricio is our director of the Center on Capacity Building for Minorities with Disabilities Research here at the University of Illinois at Chicago and his passion absolutely comes through on this particular topic. Fabricio…
Fabricio: Thank you, Celestine and let me welcome everybody. We are certainly honored to have this opportunity to talk to you about this important topic and try to share some of our experiences. I have to clarify that we are not going to actually conduct the training that we usually do because this training takes many hours. It is usually conducted in one or two days, sometimes more. So, what you are going to be getting today is like, a little preview with some of the key components of our division and the conceptual framework and how we develop this conceptual framework. And you are also going to hear about some of the experiences that two states that actually conducted training for all of their vocational rehabilitation staff and can share with you and that is the state of Alabama and the state of Illinois. But we have conducted multiple trainings in all of the Midwest; with regions involving totaling today close to 2,000 individuals with services provided. So we are very proud of the effort that we are doing to try to give back the services and the quality of the services that are available to individuals with disabilities of diverse origins. The state of Illinois has also contacted with us to provide this training online to their staff and the Department of Human Services that covers close to 14,000 employees here in the state of Illinois and we are very proud of that effort. We are also starting a program with the Great Lakes ADA that is going to make available this training for employers on a simplified version, also that is going to be available, we expect, by the end of this year. Next slide please.
What I am going to start telling with you, is how do we come up with our conceptual framework? Because we wanted to try to figure out, in the process of talking about cultural competence to give you the research and try to come up with a synthesis model, so we will have a framework, to describe the process and to relate with the participants in the training. We identified 259 peer review articles from the chapters that have been conducted in this topic. We identified 42 unique publications that refer to cultural competence models and after careful review of these studies, we came up with 18 unique competence models, cultural competence models that have been proposed in the literature. Next slide please.
As I said, briefly, we wanted to propose a synthesis model that will have the most common elements that are recognized in the literature. We did not want to reinvent the wheel but just take what was the state of the art out there. And those have basically four main components. First, willingness to engage because we realize that this process is voluntary and no one can be forced to become culturally competent. They need to believe that this is something that they need to do. Next slide please.
This is the framework that we identify and that guides us for our initial sense of training. We have decided to engage as a condition outside of the framework and then the framework itself, starting with critical awareness and moving towards increased cultural knowledge, skills development, and then putting everything together in the process of achieving cultural competency. And as you hear Celestine refer to, this is a quest, a process that is ongoing because every time that you feel that you are comfortable engaging one type of people, another completely different group of people appears in your door and then you are challenged again to try to become competent with that group. Next slide.
After several months of conducting trainings with that framework, we wonder about trying to assess the skills that we were training. So we decided to do a validation of our cultural competence model and develop an assessment instrument. Next slide, please.
In order to do that, I’m sorry, I am back. In order to do that, we look at multiple instruments that have been developed, and you can see this in all the tools that have been used for assessing cultural competence. Basically, what we did was we took the items that we thought represented best the items and conditions that were effective for our model and the components that we wanted to pursue. So we did all that, and you can read there in the presentation, I’m not going to go through all the details. But basically, we end up with an instrument that has 49 items when we first develop it. And we test these items with a group of occupational therapy clinicians and we send it to it to a large sample of OT practitioners. Next slide please.
So the sample was a random sample of OT professionals to the National Association of Occupational Therapists who received a copy of the instrument and 477 individuals responded to our request, and we conduct analysis and factor analysis, both explanatory and confirmatory. Next please.
The individuals who responded were primarily female, and white, which is a characteristic of this occupation. Fairly young adult, there were a larger proportion of people that were older than 41. Interestingly, the majority of the respondents have never received formal training of cultural competence. Next slide please.
We try to draw multiple statistical tests to see complementary factor analysis and as you can see, basically, there was highly significant testing of the factors. And the process eliminated most of the items and we end up with 24 items that explain about 45% of the variance loaded into 3 factors and each one explained about 15% of the variance. Next slide please.
So here is the model. Based on the empirical evaluation and as you can see the critical analysis component combine into one, that basically refers to cognitive elements. The skilled development component remains and basically that refers to behavioral elements and what was interesting was that a new factor emerged from the study, and this is organizational support for change. We were very pleased to see this because we realize that this is now a conceptual component. So we have both cognitive, behavioral and contextual elements now that need to be addressed in our training and I feel, we feel, our team feels very strongly that, that really gave a much better understanding because the feedback that we were getting from people is we can’t inspire people to go to their jobs and try to change the world or the job that they do, but sometimes they are not supported by their managers or their organizations in those efforts, so that cannot be decontextualized. We also wonder why is it that the literature didn’t include this component and one of our speculations is that a lot of the sources for the models up until now are driven by clinicians and clinicians tend to focus much more in their own one-on-one relationship and the contact of interaction with the individual. So in that context, the organization plays a lesser role. So we are very pleased to have that and that has resulted in changing the way we do the training because we are now paying much more attention to organizational context. Next.
We are now going to review some of the items that appear in the factors, so you can have an idea. The instrument, by the way, is available from us upon request. Next.
We are going to talk about the first factor and what you are seeing now in slide 18 is a sample of some of the items with the alpha value of .76 for this factor and the individualized for each of the items. These are some of the examples of the items, individualized for this factor. I can openly discuss with others, issues I have in developing multicultural awareness. I learn about different ethnic cultures through education and methods and/or of life experiences. I examine my own biases related to race and culture that my inference, my behavior as a service provider. I actively strive for an atmosphere that promotes risk taking and self exploration. Next.
The other items for this factor are I am sensitive to valuing and respecting differences between my cultural background and my client's cultural heritage. I feel that I can learn from my ethnic minority clients. It is difficult for me to accept that religious beliefs may influence how ethnic minorities respond to illness and disability and I do not consider the cultural backgrounds of my clients when put in demand. So these are the items that reflect the cultural awareness knowledge factor. Next.
For organizational support we also have eight questions with an alpha a little higher than .81. Examples include: cultural confidence is included in my workplace’s mission statement, policies and procedures. My organization does not provide ongoing training on cultural competence. My workplace does not support using resources to promote cultural competence and my workplace does not support my participation in cultural observations of my clients. As you can tell, some of the items were reversed and some of the items were negative. Next.
So, finally, for the organizational support factors, another example. At work, posters, printed materials and pictures reflect the cultures and multicultural background of the client. I received feedback from supervisors on how to improve my practices and skills with clients from different ethnic minority backgrounds. The way services are structured in my setting make it difficult to identify the cultural values of my client and I have opportunities to learn culturally responsive behavior from peers. Next.
Finally, for the skill development, the items include: I am effective in my development communication with clients whose culture is different from mine. I am effective in my non-development communication with clients whose culture is different than mine. I will find it easy to work competently with ethnic minority clients. I feel that I have limited experience working with ethnic minority clients and this has factor has an alpha of .81. Next.
Finally, it is difficult to practice skills related to cultural competence. I feel confident that I can learn about my client's cultural background. It is hard adjusting my telemetric strategies with ethnic minority clients and I do not feel that I have the skills to provide services to ethnic minority clients. Next.
This is the presentation of the relationship between the factors, the correlation between the factors and the learning of individual items. The bigger one measures the model and represents these values that I just mentioned. Awareness and sensitivity is correlated with organizational support at .58. Between organizational support and skills the correlation is .69. And the correlation between awareness and skills is .74. Next.
Finally, we wanted to evaluate social decidability. This is a practice in order to verify that people are not responding with biases or they are trying to mask their true values or beliefs. So we conducted a sub-study with 223 disability service providers to assess the effects of social decidability and responses to the CCAI instruments. We call it the cultural competence assessment instrument. The results indicated that there were no significant relationships between the responses to the short form of the Marlowe-Crowne scale, which is a standard instrument to assess social decidability, with regards to critical awareness, cultural skills or organizational support. Now, I am going to turn back the presentation to Celestine Willis, who is going to describe to you some additional details about the training. Celestine.
Thank you, Fabricio. Sometimes, I think it is kind of hard for people to understand how much work really goes into developing something like cultural competence training, so I want to thank you for making it clear for us. Now, I want to talk with you about what our training actually looked like. Next slide please.
So the purpose of our trainings, first of all, is to increase awareness of participants and others’ cultural identity and ethno-history, attitudes and values of cultural diversity. We want to increase each participant’s knowledge of the factors that determine cultural differences between African Americans, Latinos and Asian Americans with disabilities. We want to help participants identify ways to creating more welcoming environments to consumers from various cultures and to help plan specific actions to improve services to consumers from different cultures. And the way that we do that, help people plan specific actions, is we invite participants to set goals that will help remove the barriers that they have to serving individuals in a culturally competent way. Next.
So, our workshop themes: examining your own cultural values, knowledge and attitudes. So, I talked about that a little bit earlier when I was introducing the training. But, when you think about it, we all have our own biases. You have to stop and think, now where did this bias come from? Was it something I learned through the media? Was it something I learned about as I was growing up? Was it because of a specific experience I had? Was it with a particular individual from a specific ethnic group? Where did I get the bias? How does that bias that I have affect the way that I work with individuals? So, we asked people to look at their own cultural values. What were some of the things you grew up with? What are some of the attitudes that you have towards people? Like, for instance, one of the biases I have is that I might not, particularly, look very favorably upon some of our young people that wear the baggy clothes and big T-shirts and things of that sort. But I hate to think about that, am I not just thinking in a favorable light with these young people, or am I acting someway differently towards them, and I came to the realization that I was acting differently towards them. Because what I was doing was I didn’t take them as seriously as I took other young people that I worked with. So, in examining that bias, as I was able to cognitively say to myself, that rather than making an assumption on first impression, that I will actually try to get to know the young person first. So, we also want to examine factors that impact cultural diversity. There are 25 factors that we identify. Five of them are visible, like visible disabilities. You can see whether or not a person is in a wheelchair. But usually the first thing that you see when you meet someone, the first thing that you recognize, is their race. But that is not where cultural competency is, it is not necessarily about an individual’s race. So we have identified 25 factors that impact cultural diversity. So, age is a visible factor. You may be able to tell a person's age by looking at them. For instance, you may be able to tell if they have gray hair or whether or not they have a lot of wrinkles in their face and then even with that, you may be making assumptions about their age that is not necessarily true. Gender, we may be able to tell an individual's gender by looking at them. Appearance, and when we say appearance, what are we talking about? We are talking about whether or not an individual is disheveled, you know, whether they are clean. It can even go to the point of working with someone with a disability that has some invisible disability. Well, maybe they have uncontrollable jerking of their body. Do we treat those people differently than we treat other people? Appearance also can mean that in this country there might be a bias towards good-looking people. So these are five factors that we have to deal, that we see are visible. Then there are 20 factors that we don’t necessarily see. For instance, family and community support. We don’t know anything about an individual's family or community support and how that impacts them. Whether or not they have the things that they need in the community, whether they have the community support; looking at whether or not, how minorities even view disabilities, and how they support one another. Another question is oppression experience. You know we have to examine our own level of oppression experience, as well as the level of oppression of the customers that we are working with. Some of the people we work with are coming from war-torn countries that are very oppressed. Women are oppressed in many instances and individuals with disabilities are some of the most oppressed individuals that we can work with. So what about their knowledge of rights and services? People that are coming from different backgrounds, different world views, different countries, may not even know that they have rights and services because they did not have any in the country they came from. A sense of entitlement; when you think about different ethnic groups, you may even think that asserting oneself or their entitlements, or their rights, is rude. They don’t know it is okay to advocate for themselves. Next slide, please.
We looked at our socioeconomic level, our level of education, religion, beliefs and values. When you look at an ethnic group, you are going to find that often times there are more differences within that ethnic group than there is outside of the group. When you control for socioeconomic, education and religion, people that are on the same socioeconomic level, same level of education or practicing the same religion, are going to have more in common with someone whether or not that person is within their group or not. Degree of acculturation: How do we work with people, whether they are first generation, second generation or third generation immigrants in this country? It’s going to be a big difference. Language and social identity, whether or not a person, we are providing services in a least restrictive way by providing services and the language most familiar to people and translating the information that we give them. Immigration status and urbanicity; then, like I said, we help people plan steps to promote culturally appropriate services and outreach in their agency. One of the things about our training that make it somewhat unique and that we are very proud of is that we do not just train and hope. We actually ask people to make a commitment to develop 2 to 3 goals that will help them remove some of the barriers that they have concerning minorities with disabilities. And then our staff follows up with them for 3 to 6 months to see how they are progressing on those goals. They may have to renegotiate them depending on who was in the training, who developed the goals and how much buying you get back from your agency. That is where organizational support comes in very needed. Next slide please.
So, our social competence training, overall, we did over 50 trainings between 2005 and 2009. Now, we conducted these trainings in eight states: Alabama, Illinois, Indiana, Michigan, Minnesota, Missouri, Ohio, Oregon and Wisconsin, and as Fabricio said, it was actually closer to 2,000 staff from 68 different organizations that participated. The organizations included vocational rehabilitation, centers for independent living and community based organizations. The structure can be very customizable. We can go two hours to two days; includes lectures, activities, lots of different exercises, privilege, exercises on stereotyping and goal setting. And organizations, like I said, were invited to set goals to increase some aspects of organizational cultural competence, and some of them went beyond the six months and some people were so invested in what they were doing that they went well beyond the six month consultation. Next slide please.
So, in developing the curriculum, the curriculum for the training itself, there is a core curriculum that is already developed. But then our staff can work with the staff from different agencies to customize it. If you are working with a population, say for instance, you are working with the [indiscernible] population and you don’t feel as if you’re doing a good job of outreach, we can try to customize the training so that we can speak specifically to the different ethnic populations that you are serving. We can meet with your staff, determine your needs, in the time frame for training that is going to work best for you, one to two days, and we also have been doing some training for the trainer workshops, where we will come in and actually train your trainers, develop a facilitator’s manual for them, so that they can then go out and take the training out into the community. Next slide please.
We are going to talk to you about how we developed the CCAI and how it was validated. And one of the ways that we use is that to administer pre and post. So, pre, the training, we are coming into your agency to provide the training. This assessment instrument in organizational readiness of your teams can be e mailed to your staff for them to take the survey and then three months post the training, the same instrument is developed and then we are able to provide you with a report on your individual cultural competence and organizational readiness retained. And we felt that organizations have really been able to use these reports to say what is working for them and what isn’t and be able to really achieve some of the goals that they have set for themselves. Next slide please.
Now, before I turn this over to Fabricio, I want to go to Fabricio and see whether or not there is anything you want to add about our training?
Fabricio: Thank you, Celestine. Well, one thing that I want to point out is that the training has been also tailored to the specific needs of the states that are participating and you are going to hear some of that from the presenters in a moment. And also, we want to emphasize the opportunity that this creates for people to engage in very serious conversation and dialogue. If you think about part of the process of learning these things, really happens not by listening to us, but by engaging in conversations about these topics with the peers and colleagues in the training site. We have realized that people really need to have a safe space to have this conversation that is often difficult, that is often challenging for people to accept and engage in. This has become one of the hallmarks of our efforts that the training provides a safe space and a context for people to engage in serious discussion and conversations with each other that eventually result in changing their views, their attitudes and their perceptions. And for instance, a better understanding of their personal biases, regarding people from different races or other characteristics. For now, we are going to invite Dr. Francisco Alvarado to share some of the experiences of the state of Illinois.
Thank you, Fabricio. First of all I want to also welcome everyone to today's webinar. My name is Francisco Alvarado and I am the Assistant Director for the Division of Rehabilitation Services here in the state of Illinois. It truly is a privilege to participate today in this very important webinar that focuses on an area of great interest to our service providers. Before I start with our presentation, I just want to give everybody just a little introduction in terms of the description of the division here in Illinois. The division of vocational rehabilitation program in Illinois has a budget of approximately $800 million of which $105 million is in the [indiscernible] is for employment. We operate three vital Medicaid waivers in the home, in community-based programs, bureau of disability and termination services, pre-residential schools for students with disabilities and we also provide the funding for 23 centers for Independent Living and provide support for an array of other service providers and needs that have contact with our customers. We serve approximately 40,000 customers with disabilities in Illinois. And our primary emphasis is those with the most significant disabilities. We have approximately 45 offices distributed throughout the state of Illinois, which our staff provides services to the local offices and develops relationships with the different communities geographically. So as you can see, Illinois is a state where we that cover a large geographic area and is composed of different sectors in terms of not only community, but also industry, employment type of opportunity is differed depending on the location within the state. Well, in terms of our participation with the Center for Capacity Building for Minorities with Disabilities Research, I just want to commend Fabricio and his staff for taking the initiative in terms of developing cultural competency initiatives and develop a program and training that is meaningful and significant. Can you go to the first slide, please?
Cultural competency in terms of the training the division had participated, we had over 300 staff in the division. The 300 staff was distributed among the vocational rehabilitation program, our Home Services Program, the Bureau of Blind Services and our Program for Acquired Brain Injuries participants. The training participants selected to participate in the Research and Evaluation Program. This was an opportunity provided to everyone. Of those, 233 trainees of the training program completed the assessment and of the 233, we secured 54 post assessments. The ideal concept here was that we knew that it was vital for our counselors to be able to have the tools to be able to provide the needed vocational services that were culturally appropriate, culturally competent for our community. Our community number one, primarily because we felt that it was important for us to look at the different factors in terms of our goals, our outcomes and the quality of assistance that we were providing. We felt it was time for us to really look at our accounting skills, our capacity to transfer, our technical expertise in terms of understanding how other communities observe and understand the multi-factorial issues that affect individuals with disabilities in terms of reaching their lifelong term goals. So, in that, we conducted ten 2-day trainings, in which all staff participated in, and where we collected the data. Next slide please.
We collected the following measures. The instruments that we used were the instruments that were developed by Fabricio and Yolanda. The different components that were done that were put together to create a better understanding in terms of how the counselors and our staff were taking in the information. So, one thing that was very important to us in most of the training programs that we all attend is that we want it to be significant. We were looking at training, not where our staff was just going to be there for two days. It’s an enormous investment for the department to take its staff and invest two days of their time in the training in which they probably, may not benefit from the training. So, we felt it was really important that we have a solid training program so that we have a way to measure the satisfaction in the training, a cultural knowledge of participants before they started the training and after they started the training, so that’s where the cultural knowledge assessment came in. And the physical environment assessment also, and the cultural competency assessment of the instruments and the organizational readiness was key for us, in number five of the slide. I think it was awakening to us to see the division itself of the organization of supporting these concepts whether we are and whether we were truly ready to take that step forward to look at the changes that needed to happen administratively. And six, I think it was vital to look at the data, the goal progression and the accomplishments. One of the things that we’ve all heard in our experience was that we knew that our staff was very interested after the first day of the training. We heard tremendously from them and therefore, we included an assignment, which each office would develop their own goals, their own collective plan for improving their understanding of cultural competency in terms of how their offices function. So through the training and working with Celestine and Fabricio and their supervisors, they were able to develop an individual office plan, with goals, time lines and specific outcomes. Next slide please.
The satisfaction with training, as you can see, I don’t want to go through it very much in detail, on a scale of five, we had a very high rating in terms of satisfaction of the training, and also of the trainers. So, that was very good. We see that our staff was able to evaluate and assess the contents of the training and they communicated it was of important value. Next slide please.
The cultural competency assessment was the instrument that provided us with an analysis of the pre and cultural comparison, in terms of the knowledge of the participants, their awareness, organizational support and skills. You can see there is an enormous overestimation of the initial components, in terms of the pre. Most of the participants overestimated their knowledge. And then in the pull sector, they were able to understand that they had a less or lower level of understanding, culturally at the beginning or before the training in terms of their assessment of themselves prior to initiating the training. Next slide.
The cultural competency assessment instrument slide looks at the critical awareness, the cultural skills and organizational support that could be measured at the baseline, in terms of the pre and the post. We are still looking at that these. We haven’t received all of the information. It is still under analysis. Next slide.
Organizational readiness for our staff, in terms of change, change in what we look at, in terms of our staff and in regards to their effectiveness and growth in our organization. This is what is key for us to be able to focus on how we are adapting, how our staff is actually improving their knowledge and applying it with varied results. This is also an area that we are receiving more information on and continuing to analyze. It is serving us tremendously in terms of our direction as an organization and for our future administrative direction. Next slide please.
The organizational readiness for change in staff, staff change, staff efficacy, staff availability, as you can see, the factors here, they are looking at a lower score here in terms of staffing. Of course in these tough times, all organizations are trying to maintain staff and trying to bring on new staff with fewer resources. So, it is an enormous challenge for us. And that was something that was clearly identified in terms of our organizational needs and to continue to grow and develop. Next slide.
The organizational readiness for change of climate, as you can see, we had a post and a pre. The pre assessment looks very promising and after the post comparison, you can see that it shrinks down in terms of their understanding of how the organization can or is ready to change in terms of a climate of understanding to overall cultural competencies. So, I truly feel that the training was very enlightening to all of us and we continue to work with our offices and we continue to receive feedback from them as a result.
Organizational readiness for change in climate; the climate in terms of cohesiveness, autonomy, communication, stress, leadership: these are all factors that are important to the everyday function of our counselors, our offices, in terms of how they interact within themselves, the relationships with other offices and the community and, especially, if they translate into quality customer services. Therefore, it was vital for us even to measure these factors in terms of cultural understanding and the factors of how they apply to different communities and understand disabilities, in different ways and different formats. So, in order to build a better understanding of where we are with these factors and what was developed, we are still looking at the data and we hope we will be able in the near future, have more information with how we changed, and how we can better understand ourselves as an organization. Next slide please.
Our goals in terms of accomplishments in regards to the adventure, the journeys of cultural competencies, we looked at 37 VR offices and 10 VR contracting communication organizations, and the brain injury programs, which all participated in telephone interviews. We looked at the 47 groups set out all the 98 goals have offices. The 42 groups, 92% of them engaged in the follow along process and resulted in tracking about 95 goals, which approximately 97% of those were on track and ongoing. This slide refers to the goals that were identified by each office in terms of what areas achieved they were looking for that they needed to establish in their offices to ensure that they could apply the understanding acquired through the training.
Measuring goal accomplishments, types of goals, types of facilitators, identify the barriers, level of goal accomplishments during follow-up interviews, these were the areas that were conducted by Celestine, in terms of the follow up with our offices and counselors to in order to identify how they were working towards the goals that were established in each one of the offices and if they were actually working towards them in a meaningful manner.
Goals set example, from the examples of the goals that were designed by each one of your offices to improve the organizational practices. We have increased cultural understanding into the intake process from the point of the entry in all of our offices, from the point of the person who has contact, whether it’s through our front door or our phone or whether it’s electronically, to figure out a way to look at our ability to use our cultural understanding of everyone that accesses our services. To provide better bilingual services, look at a system that is friendly for non-English speakers and that requires language support, to be able to provide them in a way that is seamless and that is natural to the counseling process. To improve our cultural elements or physical environment, to look at the way that our offices appear to be friendly, not friendly, intimidating of government offices, communities, maybe to look at how we can make them more welcoming. In forming cultural competence committees, each office is looking at forming a community in their offices that take charge in terms of looking at needs and follow-through with regards to what the offices are establishing in terms of their goals. Increase the diversity of the workforce; this is an important area for us, especially because we are a workforce entity. We felt that it was highly important that our offices reflect the community that we serve. So, we’re looking at possibilities of seeing how we can recruit and work with the different universities that provide Master’s training in the area of vocational rehabilitation and see if we can identify counselors’ backgrounds. Evaluate and improve the effectiveness of services. Very little in the past have we ever really looked at including questions about cultural competency, in the way that we assess services that we provide and we review cases on a monthly basis. So, on our review sheet, we are looking at including aspects of cultural competency or language services provided or language services offered to the individual, examples of that nature. Improve outreach and linkage of the organization and the community. Improvement is important for us to develop these relationships, like community events and activities, so not only can we get to know them, but they can get to know our local offices and our staff. Next slide please.
We want to share with you that the people within the administrations who provide the support or assistance to goals, in regards to staff and management, we needed to identify everybody who has that responsibility of providing the services not only within our offices but also other providers in the community and working with the Center for Capacity Building and Minorities with Disabilities Research, who really created and developed the training program and their staff that assisted us in developing and continued to develop our cultural competency.
Some of the barriers that were identified were the lack of bilingual staff, the lack of financial resources, lack of time, lack of diversity among staff and management, the reluctance to change among staff and management. You will see that some of these challenges are not unique to Illinois. They are unique across the nation. So basically, at least at this point, we have gone through the training and are looking at these issues and are developing plans and goals and corrective measures. We need to look at how to best serve the different communities. Next slide.
The level of goal accomplishment, this is the goal status at the final follow-up. We have a total of 18 that are ongoing or are on hold for different reasons. We have total of 13 that we are primarily in pursuit and 15 that we’ve identified that were nonessential in terms of continuing at this point. The majority of the reasons of the ones on hold are primarily because of the lack of financial resources. Well, before I turn it over, I want to ask Fabricio if he wants to add anything.
Fabricio: I want to thank everyone for their time and for this opportunity for Illinois to share our experiences with you today. We hope that once we have completed all of our analysis and data, we will be able to share with you in the near future.
Thank you, Frabricio. And I have to tell that collaborating with the state has been a great pleasure. We have tremendous support from the leadership of the institution. As you can imagine, like every state, it is a large institution, very difficult to maneuver, very difficult to handle. But, the leadership is totally committed to improving the quality of services and making more resources and more opportunities available to individuals with disabilities of diverse cultural backgrounds. I just want to emphasize that in the last data point about the total payment, 35% of all of the goals that were set were accomplished at follow-up and 52% of all of the goals were in progress or had been already accomplished, when we had completed our follow-up. The picture is very positive, as you can imagine, some of these goals did require vocational resources, changes in the way the organization was operating and functioning, and it’s been really nice to see that now many business have incorporated conversations within their monthly agenda, in their monthly meeting, conversations about aspects of diversity, about how are they are dealing with those issues and how they are implementing and allocating their resources involving other community agencies and staff in better serving people with disabilities from diverse cultural backgrounds. And now, it is my pleasure to introduce Gwenea McDaniel, who is here to talk about her experience in Alabama.
Gwenea: Good afternoon and thank you so much. I want to start off thanking you first of all, Fabricio and especially, Celestine, for working with our state so diligently and providing this training to our staff. I’ll also give you a little idea of the state of Alabama. We are very fortunate in that we are a department. In 1995, we became our own Department. Prior to that, we were under the Department of Education, so we are very proud that we can say that we are our own department, which makes everything run much smoother when you don’t have to go through so many channels. We’re also very unique in Alabama in that we have what we call, a continuum of services. That means that we serve individuals from birth all the way to older age in our four different service delivery programs. And they consist of our early intervention programs, our children rehabilitation programs, our vocational rehabilitation and our state of Alabama Independent Living Program. We have, approximately, 770 staff members and with each of those programs you can imagine the different disciplines. We have over 78 different disciplines for each of those programs within our department. We of course serve all 67 counties in the state of Alabama. We have approximately 25 different offices. Some of those offices include all of the different programs and then, others, particularly, like our children’s rehabilitation program; some of them have their own standing offices around the state. I was asked a question: what happened to make us start on this journey? And I was pleased to say that nothing really happened. We pride ourselves on being on the cutting edge of wanting to be proactive instead of reactive. In fact, a full time position was dedicated in 2002 to address diversity and recruitment within the agency. I was very fortunate to be selected in that position. The realization was our impending reality of natural attrition due to retirement because of our aging staff and the national shortage for qualified rehabilitation professionals to look for candidates for employment was what inspired our leadership to develop this position and develop plans to address these issues. The diversity team and I know that you have all mentioned that having organizational support is a must, and I must say that our agency definitely supports this initiative; it consists of our commissioner and several of our department heads. They developed a recruitment plan so that we could address succession, as well as a diversity plan and in keeping with our mission to allow Alabama’s children and adults with disabilities to reach their maximum potential, we developed a diversity plan whose vision is to promote a respectful, equitable and fair environment for staff and to provide services to consumers that recognize, accept and utilize the skills, knowledge and abilities of diverse individuals. Next slide, please.
We also have values for our staff that their contributions to achieving our mission and also valuing the work, dignity and rights of people with disabilities. Next slide please.
Our diversity plan, we actually approached this a little differently. One of the things I’d like to commend Celestine and her staff for tailoring it to meet our needs. We actually have a diversity plan already developed and we looked at our strengths, weaknesses, opportunities and threats and identified goals that we wanted to achieve and these are the goals to have an agency leadership committed to formulating a diverse staff that understood the meaning of diversity and to have diversity of staff reflect the diversity of the general population of the state and, ultimately, to provide culturally competent services to our consumers. Next slide please.
We had approximately 741 staff members to participate in this training. We have only approximately 30 people that have not participated due to scheduling and that type of thing. 97% of our staff was able to participate. The logistics of that for us, we do have a registrar system, which is a system by which our staff can register to take training in certain areas. We had to determine was it more feasible to have them all come to certain locations for training or was it more economically feasible for us to take the training to them? And for us, we decided to take the training to them. We had 15 one-day training sessions and again, that was in tailoring it to meet our needs. I know it can go up to two days, but we were able to tailor it to a one-day training, so that everyone could travel, if they had did have to travel, to and from the location in the same day, which cut down on costs for us. Our training was all over the state. Montgomery, that very first training, we actually identified the participants for that training and it included our administrative staff, our state office staff, we wanted them to have the initial training and their input actually led us to tailor it even more when we rolled the training out to our staff in the areas. Next slide please.
We collected information. We looked at our satisfaction with the training. We looked at the cultural competence assessment instruments (the CCAI) and the organizational readiness for change. Next slide.
The satisfaction with the training, Celestine was actually our trainer who did an excellent job and we are very pleased with not only the content of the information, but also the delivery of the information. Fabricio stated that it allows for people to actually dialogue with one another. We felt that as well. One of the reasons we chose this training was because it was consumer-focused and also because we could tailor it. We could research all kinds of information about diversity or cultural competence, but when we saw that it was tailored to serving consumers, we were more interested and then was able to get additional information about how it could work for us. The rating of the training, looking at the ideas presented, the level of interest of our employees in the training, the opportunity to learn new skills, all that yield a rating of 4.33, and then if you look at the rating of our trainer, it was even greater than that on a 5 point scale, at 4.78. And that was a return of 628 surveys and of course the 15 one-day trainings. Next slide please.
This data here for our cultural competence assessment instrument, this was given to our staff prior to participating in the training and we are still waiting to roll out the post. We have approximately two more weeks before the three month period, to roll out the post, so we are anticipating getting that in the middle of March, before our staff, so we can evaluate the pre and post. But our critical awareness at that time, of course, was the 4.41 and then the cultural scale at 4.25 and the organizational support at 3.87. I personally am looking to see how the organizational support reflects in the post because sometimes I think the people in the state office are working on things but the people in the field may not see it. But, having this role actually in their areas, I think they should see that the agency is definitely committed to cultural confidence. Next slide please.
Our organization ready for change; our staffing as you’ll notice on this chart, is the lowest one and I would attribute that to a hiring freeze. We’ve actually have been on a hiring freeze going on two years now, governor opposed hiring freeze, which many agencies are feeling the crunch of the financial crisis. We too are experiencing that, so that there well may have affected that. Hopefully we can get another picture of that after the post. With the staff training, we pride ourselves with training in the many disciplines, as well as the overall training that would more effectively assist our people and serving their consumers. The staff efficacy and how they can perform their job and their ability to change with the 4.49. Next slide please.
The organizational readiness for change, looking at the cohesion of our offices, the economy, their communication, stress, the climate for change in the leadership; these are also on a six-point scale. But looking at those numbers, the stress and the shortage in the ability to hire, we know that people are doing more work because we are not allowed to hire the people to fill those positions that are vacant and that is our very lowest one and then climate for leadership, looking at the skills and being recognized for what they are doing out there in the field of serving consumers. Next slide please.
Overall, we were very pleased by the training. It’s actually a part of our diversity plan to develop a curriculum for diversity training within our state. TACE has been very instrumental in us providing this training and will also participate in continuing to develop our entire curriculum. We have what we call a Diversity Task Force, which consists of staff members from all diverse backgrounds, all different disciplines within the state, that are talking to their people in the field, the direct service people as well as their co-workers, in getting information about what types of training they would need, not only to serve their consumers but also work with their staff. We know that the climate is changing and the demographics. We know that the people we recruit to replace our vacancies can be from various different backgrounds, so we not only need to focus on service delivery, but we also need to focus on working with our fellow co-workers as well, and having cultural competence in order to do that. And Fabricio and Celestine, would you like to add any comments regarding the training for Alabama?
Fabricio: Well, I would like to clarify because some of you might be a little bit confused that we did change the scale of the instrument in Alabama because based on our previous experiences; we were concerned that people were having a very close to a [indiscernible] effect because they tend to over score themselves as a base level. So we decided to change that. And we are pleased that at least the base line in Alabama, that has now a six-point scale, is more closer to the middle, which is going to, we hope, be a better representation for the analysis of the post data once we start recruiting that data. So we are looking forward to that data collection starting in about two weeks. Celestine, would you like to share some additional comments about the Alabama experience?
Celestine: Well, I want to share some comments about Illinois and Alabama. First of all, it has been on a real pleasure working with two organizations that were very dedicated to having positive outcomes for their consumers. So, that was really great, it was very easy to work with Illinois and really easy working with Alabama. Although, Alabama did drag me all over the state in heels, I know every back road in Alabama right now.
Gwenea: We wanted to give you the scenic view.
Celestine: And, that they did. We actually had to lead Alabama when I was in Mobile and drive through Florida to get to Alabama. So I can truly say that I saw all of Alabama, but it was a real pleasure working with both of the groups and it was really interesting to listen to some of the issues that both were having in Illinois and Alabama and then be able to provide them with some tailored training options that would help them. So, what we would like to do now is open it up for comments and questions from our participants. So far I haven’t seen any, but I’m going turn it over to Steffany to check with the participants about questions or comments.
Steffany: Okay, it looks like I see a question. If you have any questions or comments, post them in the public chat. It looks like Courtney Newman has a question. Her question says: how much of the cultural competence training addresses understanding of their cultural identities compared to helping participants to discover and evaluate their own personal biases?
Celestine: Fabricio, do you want me to take that one?
Fabricio: Yes please.
Celestine: Okay, thanks for that question. First of all, I think that it is really important that you examine your own biases, but it’s clearly important that you understand the population you are working with. We have a lot of information geared to specific ethnic and racial groups. So, I would tend to say that there is actually more emphasis on the specific ethnic and racial groups and how to work effectively with them, once we get beyond looking at our own biases. I wouldn’t say that it is overly weighted with our own personal biases and values, but that is the foundation that we start with, but it does absolutely look at specific groups. Does that answer your question, or do you want me to go into a little more detail about that?
Fabricio: If I can add a comment to that, Celestine, for anyone considering the training, is you know, you talked about tailoring. In Alabama, we actually identified certain cultural backgrounds or races based on the consumers that we served. So we were able to tailor it, so that we could get the information to specifically help those populations within our state was very helpful to us.
One thing we tried to avoid is stereotyping. Every time that we talk about a particular group, we remind people of the multiple factors that characterize human diversity and we emphasize that every individual, they might be from the same ethnic group, is different. We are trying to help them understand common elements and, specifically, how to problem solve when they are faced with specific situations like access to the language translation. For instance, we know it is a process that individuals need to follow and call upon them to get it translated. Thank you.
Steffany: Any other questions? Are there any more questions, please type them into the public chat at this time.
Okay. You can put the next slide up. I just want people to know that if you want more information on the Center on Capacity Building for Minorities with Disabilities Research you can contact me. This is my e-mail address: willisc@uic.edu. This is my direct phone number: (312) 413-8993. Thank you so much for participating. I’m going to turn it back over to you Steffany, since we did not seem to have any more questions.
Thank you, thank you so much Celestine.
As you will see, her information is on the screen and it is also on our website. I will go to the next slide. Thank you all for your participation today. I would like to let you know that the contact information for TACE is before you. And I want to thank our presenters for the information they gave us today and appreciate the time you have taken to present your expertise to our audience. The transcript of the session along with all of the handouts will be available on the TACE website within approximately two weeks after the session and you can find that website at TACEse.org. Please remember to complete your evaluation of today’s session. You feedback is important to our continued planning so we can address your specific need and concerns. As with all our presentations that offer so much information, if you have any questions that come up, you can send them to our TACE e-mail address, which is on this screen or you can give us a call toll-free and that number is on the screen also.
This session has been approved for 2 CRCC credits and .2 CEU credits and those have to be done by Tuesday, February the 23rd. Well, thank you so much.
Question: Before we go, I see a question here. I see one from Missy Samburg. She said to be completely culturally competent; do we have to provide services in every language? Fabricio, would you like to take that one?
Fabricio: I would like to defer that to the people from VR. What do you guys think?
Answer: Well, I think definitely to serve our consumers we definitely need to make every effort to make sure that we have information to provide to consumers. Now, to be culturally competent, I think that is another level, I think that those are two different questions and two different things actually. For us, we utilize interpreters, we utilize the language line, you know we have access to different resources that would allow us with communicate if someone even if they are dropping in or if it’s a scheduled appointment. So we make every effort to provide services in their language.
If I might add, that is a very good answer; I think that the language is a necessary component for engaging in communication with the client, but it doesn’t necessarily guarantee that he/she will feel welcome, that he/she is going to be treated in a way that he/she is going to feel appropriately accepted. So, yes, as you pointed out, these are two different things.
Question: Okay, it looks like we have another question from Janet Ericsson. And it says: are we really providing a service if the person cannot understand the interaction?
Well, we are not providing a good service, that’s for absolutely sure. And you know that it is really important that we serve people in the least restrictive way. So, if a person cannot understand the interaction that you’re having, then you’re not going to be able to provide them with a good service. So it’s really important and that’s where it comes in, whether or not a person is acting culturally competent or not because if you’re not working in a culturally component way, then you don’t even recognize the fact that you’re not providing a good service to the individual if you are not providing it to them in a language that they can understand. But, if you do realize that, then you do realize that you need to work towards providing them with that information in order to be able to work towards becoming culturally competent. You are absolutely right; you are not really providing a person a very good service if they cannot understand the interaction. Does anybody else want to add to that?
It is also an issue of the rights of the consumer to be served appropriately, in the most appropriate way in. So, in some cases, this is regulated by the policies of the program.
Absolutely. Thank you. That was more of a comment, but those types of comments help us to start really thinking though and we don’t make those kinds of comments to one another sometime. And it is hard to get out of our way of thinking of only doing things one way. Okay.
Are there any more questions? Okay. Thank you to our presenters and with that I will bring this session to a close and we thank you very, very much and we look forward to your participation in future sessions. Have a great day.
[Event Concluded February 17, 2010]