United Way of King CountyUnited Way of King County Community Assessment - King County review of health and human services

Cultural Competency


The health and human services system in King County is known for drawing on the strengths of mainstream and community-specific organizations in the non-profit and public service sectors -- to deliver responsive, culturally competent services that more effectively meet the needs of vulnerable and increasingly diverse populations in King County. Provision of culturally competent services can be one component of promoting racial equity. Collaboration among organizations with unique and complementary strengths is key to addressing changing demographics, social justice issues and disparities, and citizen and donor expectations for better outcomes and solutions.

Outcomes

These outcomes have been defined by the United Way of King County Service System Impact Council as markers of success in the area of cultural competency.

  • Evidence of greater numbers of effective, local collaborations that pair mainstream organizations connected to resources, with community specific organizations that have relationships with vulnerable populations.
  • Evidence of improving outcomes for bellwether social and health conditions (e.g., diabetes care and treatment), where vulnerable populations often lack access to services and have tended historically to suffer more precipitous declines in health status and overall well-being.
  • Increase the number of nonprofit health and human service organizations that formally adopt cultural competency best practices (principles, behaviors, policies and structures) that will enable them to work effectively among and across cultures;
  • Increase the number of nonprofit health and human service organizations that incorporate cultural competency best practices (principles, behaviors, policies and structures), that support cultural competency and better client & community-level outcomes, in all aspects of their policy making, administration, practice, and service delivery.

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Context

The multiplicity of definitions for cultural competence constitutes a major barrier for the application of cultural competency to service delivery and organizational assessment. Nevertheless, organizations in King County are finding a definition of cultural competence that can be put into practice and provide a framework for the development of culturally relevant services and culturally appropriate organizational structure.

Cultural competence is thought of as a process in which people and organizations have acquired population-specific knowledge, developed culturally-specific skills and have a comprehensive awareness of power and privilege as it plays out on interpersonal and systemic levels. In particular, it is the promotion of quality services to underserved, racial/ethnic, or otherwise marginalized groups through the valuing of differences and integration of cultural attitudes, beliefs, and practices into diagnostic and treatment methods, and throughout the system to support the delivery of culturally relevant and competent care .

Cultural competency exists both within service delivery to individuals and on an organizational level. Depending on the context, cultural competence encompasses a variety of characteristics. On both an organizational and individual level, cultural competency is the promotion of quality care and service to culturally diverse populations in a manner that incorporates these differences into service delivery. The aim is to provide culturally and linguistically appropriate services that are effective at reaching targeted populations and reducing disparities that exist across groups.

On the interpersonal level, cultural competency entails:

  1. Acquiring knowledge about an individual’s particular culture, values, customs and principles while also making room for their unique experiences and particular cultural manifestations.
  2. Allowing the individual to be the expert in his/her own life
  3. Respecting and valuing an individual’s cultural domains and experiences
  4. A consciousness of the "dynamics" inherent when cultures interact

Within organizations, cultural competency encompasses:

  1. Having staff, boards and executives that represent the ethnic diversity of the populations it serves.
  2. Hiring bi-lingual/bi-cultural staff
  3. Offering linguistically-appropriate written materials
  4. The institutionalization of cultural knowledge
  5. Development of adaptations to service delivery reflecting an understanding of diversity between and within cultures

Overall, cultural competence is the integration and transformation of knowledge about individuals and groups of people into specific standards, policies, practices, and attitudes used in appropriate cultural settings to increase the quality of services; thereby producing better outcomes (Davis, 1997) . Fundamentally, cultural competency denotes a commitment to social change.

Important to note when thinking about cultural competency is it not only pertains to racial/ethnic classifications. In order to work towards culturally competent service delivery, service providers should have an awareness of how dominant systems of care may not be effective for a variety of marginalized groups.

In fact, many groups experience disproportionate care when their unique needs and experiences are not taken into account. For example, Public Health Seattle & King County conducted their health disparities assessment and found that not only do racial/ethnic minorities experience disparities, but health inequalities existed for other groups such as the elderly, women, disabled populations, the poor, those in rural areas and sexual minorities.

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Population Data

While the population for the community assessment is all residents of King County, United Way is focusing attention on ensuring that the human services system meets the needs of vulnerable populations. These populations tend to experience more marginalization from and less access to mainstream service sectors. Some of the common demographic groups that may experience language and cultural barriers are identified here. 

Population with Limited English Proficiency

The ability to communicate and comprehend the English language is a critical life skill set for residents in King County where most business and civic discourse is undertaken using the English language. In the winter of 2006 this issue briefly came to the forefront when a number of non-English speaking residents died during a widespread power outage due to gas poisoning.  Despite mainstream media coverage warnings did not reach these vulnerable populations. 

Illuminating the breadth of our county’s cultural diversity, the Office of the Superintendent of Public Instruction identifies 150 languages spoken by children in Limited English Proficiency programs in public schools across King County in 2005. In fact, King County was ranked as the county having the second highest linguistic representation in the United States. The most concentrated diversity of languages exists in South King County, with 117 languages; while East King County is home to 78 different languages. 

A society heavily dependent on the English language, coupled with limitations in the ability for many to communicate in English, results in diminished opportunities to seek and receive services. More debilitating yet is when an entire household has limited English speaking capacity, a population the Census refers to as “linguistic isolation.”

The 2005 American Community Survey estimated that 53,125 households in King County were “linguistically isolated.” This represents 26.3% of households where English is not the household language. Specifically:

  • Spanish speakers 26.8% were isolated
  • 19.7% of Indo-European speakers were isolated
  • The Asian non English speaking population showed 30.5% were isolated
  • Other Languages reported 28.0% were linguistically isolated

Within the school districts, the OSPI Limited English Proficiency (LEP) program tracks participant numbers rather than all students with a primary language other than English. This may under-represent some of the rich variety of languages in the region . What we do know, however, is in all of the King County School Districts, there are almost 25,000 school age youth who have limited English speaking proficiency.

The number one non-English language spoken in King County schools is Spanish, representing 42.1% of limited English proficiency youth compared to 57.9% of all other languages combined.

South King County has the most students with limited English proficiency (with over 14,000 students). Coupled with the highest diversity of languages, the South subregion has needs vastly different than the other areas.

This places additional demands on these schools to ensure youth and parents are effectively receiving the information they need and progressing at the same pace as the other students.


Source: Washington State Office of Superintendent of Public Instruction (OSPI)

Racial/Ethnic Diversity
  • The number of people in King County with Hispanic/Latino ethnicity, is expected to grow from approximately 95,242 in 2000 to 145,906 by 2011;
  • The number of people in King County with Black or African American backgrounds is expected to grow from 93,875 in 2000 to 110,502 in 2011;
  • The number of people in King County with Asian backgrounds is expected to grow from 187,745 to 269,670 in 2011.
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Download Data   Source: Claritas 2006 Update (Census Tract Level),
 

In 2000, the foreign born population represented 15.4% of the total King County population.  In 2006, that number rose to 19.9% . White, African American-Black, Asian, Pacific Islander and Other Race all increased in their representation; while American Indian and the category 2 or More races decreased.  For reference the populations for American Indian and Pacific Islander are not included in the graphic due to the low numbers (486 and 3,781 in 2006, respectively).


Download Data Sources: 2000 U.S. Census Bureau,
2006 American Community Survey

Older Adults

Beyond race/ethnicity and English proficiency, other groups experience vulnerabilities to mainstream systems of care. Older adults are one group that should be incorporated into notions of culturally competent care. In King County, the age distribution is shifting towards the older end of the spectrum. Trends highlight an aging baby boom population that accounted for 10.9% of the King County population in 2006 and a projected 12.4% of the population by 2011.


 Download Data  Source: Claritas 2006 Update (Census Tract Level)

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Status of the Service System

There is a growing consciousness of the importance of culturally relevant services in our community. Organizations and institutions have realized that cultural relevance, in addition to being socially just, also has a direct impact on overall effectiveness. This awareness has propelled an increased commitment to understanding why and how culture has influenced and continues to impact organizations. Another concrete way institutions and organizations have been moving towards more cultural relevancy is the increase in the recruitment and hiring of bilingual/bicultural staff. This is an acknowledgement and recognition of the unique skills and experience they contribute to organizations.

There continues to be momentum as organizations develop their ability to offer culturally relevant services and become more culturally competent organizations. There are great opportunities, not only to continue to increase the number of bilingual/bicultural staff, but also to seek a deeper analysis of the impact of culture, provide concrete skills for staff, increase the inclusion of diverse perspectives, create appropriate power sharing strategies, support and develop community leadership, and establish structural policies and procedures to ensure a continued emphasis on cultural relevance.

Culturally Competent Service Delivery

Various organizations and groups around the county have conducted community needs assessments from members within those communities as well as community service providers. The Communities Perspectives report from East King County worked with immigrant and refugee communities in identifying specific challenges they face to accessing services. Some of these include: transportation, immigrant status, understanding the system, communication and legal considerations.

Many undocumented immigrants and refugees (as well as others who are not yet citizens) do not seek services because they are reluctant to enter buildings perceived as government-affiliated buildings for fear of deportation. They do not understand immigration law, and they often have no health insurance, no bank account, no form of identification, and no Social Security number. Without these resources, they have trouble finding, qualifying for or receiving the assistance they need. It should be noted that these concerns are applicable to refugees and immigrants in other regions of King County.

In order to bridge mainstream systems of care with specific vulnerable populations, there is a program in East King County that connects specific immigrant groups to resources within various service systems. Currently, materials are offered in 5 non-English languages. This model could be implemented in the other regions of King County and targeted to more vulnerable communities. Group-specific programs seem to have the most success in reaching vulnerable populations; however, there is evidence that intermediary programs coordinating between group-specific and mainstream services can also be effective in filling service delivery gaps.

For most cultural groups living in King County, there is a dearth of information: from demographic data to descriptive experiences to data on disparities in the service system. This lack of knowledge constitutes a major gap in the service system. If we do not understand the characteristics of a given population, how can we effectively and competently deliver services?

There are specific cultural/ethnic groups who have been able to conduct their own community needs assessment and report their findings to the service systems in King County. This type of community-generated assessment is inherently culturally competent since the community itself is steering the agenda and producing the report. Furthermore, since it would be coming from within the community, it might be more comprehensive than if an outside system attempted this task.

A great example of this approach was with the Arab-American community. In 2005, the Arab-American community generated a report highlighting their community’s characteristics, gaps in service delivery, and recommendations. Two major barriers in accessing services for the Arab-American community included language barriers and a perceived lack of cultural competence and understanding of the Arab or Muslim cultures . These barriers extended most notably into the health care system for this community. And even though most Arab-Americans speak English at least somewhat comfortably, these barriers may reflect a need for cultural sensitivity more so than actual services in Arabic.

Cultural Competency at the Organizational Level

Structurally, many organizations have been undertaking a self-assessment process in order to determine what areas of workplace practices, policies and culture are inconsistent with a culturally competent framework.

In 2007, we surveyed 183 organizations about how they were incorporating culturally competent tools and practices.

  • 76% indicated that all levels of staff participate in cultural competency trainings
  • 87% indicated that cultural competency training is ongoing
  • 78.6% of organizations regularly conduct assessments and evaluations of client service data to determine cultural competency needs and update strategies
  • 52% reported an active process of developing or implementing a cultural competency strategy/plan
  • 83% of these organizations reported that staff is representative of the target population/community

Even though this data does not specifically define how these organizations are shifting towards more culturally competent entities, it does highlight the intention and effort being funneled in this direction.

Another aspect of cultural competency at the organizational level consists of cultural representation of staff and in boards reflecting the population served. Many of the group-specific organizations have cultural and linguistic matching of their staff and clients for many cultural groups (though rarely for all groups receiving services).

For instance, 86% of the staff for one such organization serving refugee and immigrant communities consists of refugees, immigrants or ethnic minorities. Furthermore, this staff speaks 25 different languages, thereby bridging the linguistic gap that so often afflicts service delivery systems.

Some organizations are working to ensure that participants guide and inform service delivery through client or participant involvement boards. Given that cultural competency is best directed by specific populations themselves, organizational and system oversight and guidance by these groups is tantamount to truly operating in a culturally competent manner.

Best Practices

Go to the index to best and promising practices

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2007 - United Way of King County - Questions and Comments?