Telting Final Exam

Cultural humility

lifelong commitment to self evaluation and learning

emphasizes relational accountability, equity, and mutual respect

cultural competence

ability to work effectively across cultures (considered milestone)

person/family centered care (PFCC)

focuses on collaboration with individuals and families

core concepts of patient/family centered care

respect and dignity

information sharing

participation

collaboration

required implementation of PFCC

investment of time by clinician

training and education

learning about cultures

self reflection and cultural awareness

consideration of social determinants of health (SDOH) impacting patient

modifying treatment approaches, building relationships, teaching strategies to patient and care partners

medical models

emphasizes deficits, symptoms, etc.

social models

emphasizes context and participation

ethical principles

autonomy, beneficence, nonmaleficence, justice, fidelity, integrity

beneficence and nonmaleficence

do good and avoid harm

fidelity and integrity

requires honest, respectful, and trustworthy relationships with client and families

dynamic assessment

test-teach-retest format, focuses on learning potential

static assessment

traditional testing format (e.g. standardized tests)

disproportionality

over/underrepresentation of certain groups in special education

linguistic bias

when tests do not account for language variation

use of interpreters

best practices for working with multilingual families

code switching

alternating between two languages/dialects

health disparities

differences in health outcomes due to systemic inequalities

structural racism

system-level processes creating unequal access

social determinants of health (SDOH)

conditions in environment where people are born, live, learn, work, etc. that affect health, functioning and quality of life outcomes and risks

external factors influencing health: income, housing, education

5 domains of SDOH

economic stability

health care access and quality

education access and quality

neighborhood and built environment

social and community context

bias

implicit or explicit prejudice in decision making

interdisciplinary collaboration

working with professionals across fields

inclusive education

ensuring students with disabilities are educated with peers

culturally responsive practice

incorporates students/clients cultural backgrounds into care

family engagement

involving families in decision making

intervention planning

goal setting with the individual/family; strengths based approach

cultural competence continuum model

cultural destructiveness

cultural incapacity

cultural blindness

cultural pre-competence

cultural competence

cultural proficiency

cultural destructiveness

denying services due to clients cultural or linguistic background

cultural incapacity

licking capacity to help clients from all racial, ethnic, and linguistic backgrounds

cultural blindness

providing the same assessment material to all clients regardless of cultural background

cultural pre-competence

attempting to make some changes and to improve aspects of service delivery

cultural competence

accepting and respecting cultural and linguistic backgrounds and values by adapting services to meet the individuals needs

cultural proficiency

actively seeking to increase others’ cultural competence (e.g. engaging in research, developing new techniques, etc.)

cultural competemility model

awareness

skills

knowledge

encounters

desire

awareness

self-awareness, sensitivity to biases/prejudices

skills

access to culturally responsive ways of interacting, culturally appropriate assessment tools

knowledge

cultural world views, conceptual and theoretical frameworks concerning various cultures

encounters

cross-cultural interactions, cultural exposure, practice

desire

willingness to self examine

reflective bias

examining ones clinical decisions, recognizing personal bias and limitations, not optional, not just thinking about your feelings, using standards, evaluating outcomes

reflecting in action

reflecting as something happens

reflecting on action

reflecting after something happens

types of barriers in clinical practice

structural

cultural-linguistic

institutional/systemic

structural barrier examples

transportation, scheduling, insurance, lack of interpreters

cultural-linguistic barrier examples

different norms, values, communication styles

institutional/systemic barrier examples

racism, ableism, linguistic bias in assessments

equality

giving everyone the exact same resources and opportunities

equity

giving people specific resources based on their circumstances to provide a fair outcome

what are common breakdowns in communication?

eye contact norms

use of silence or indirectness

family roles and expectations

biomedical notions of success

reaching norm-referenced benchmarks

adhere to prescription interventions

eliminate/reduce symptoms

cultural notions of success

honor and respect religious customs, ancestors and elders

maintain harmony in spirit or emotion

emphasis on PFCC

tolerance/acceptance of difference

why didn’t Lias family have a traditional New Year’s ceremony?

Lias illness required constant care and hospitalization, led to limited money and resources especially as refugees.

Family believes her spiritual condition made certain celebrations difficult

struggled to adapt to a new country AND preserve traditions of Hmong culture

why was assimilation difficult for Hmong refugees?

came from rural mountain villages w/ little education, unable to read or write (American health, school and government were confusing)

English was unfamiliar

Hmong beliefs conflicted with western medicine, leading to misunderstandings

Arthur Kleinman’s 8 cross-cultural questions

what do you call your problem?

what do you think caused your problem?

why do you think it started when it did?

what does your illness do to you? How does it work?

how severe is it? Will it be short or long-lasting?

what kind of treatment do you think you should receive?

what are the most important results you hope to receive from treatment?

what are the chief problems your illness has caused?

why would Kleinman’s 8 questions helped Lia’s family if the doctors asked?

learned Lia’s parents believed her epilepsy was a medical and spiritual condition

understood why family wanted a shaman involved w/ treatment

could have explained medicine in a way that respected Hmong beliefs

developed trust and better communication with family

explain this quote: “if you can’t see that your own culture has its own set of interests, emotions, and biases, how can you expect to deal successfully with someone elses culture?”

doctors and Lia’s family have their own set of beliefs. neither truly realized their own beliefs were culturally shaped. since both believed their approach was correct, they were unable to understand one another. this led to many complications in how Lia should receive care

explain this quote: “Lia’s life was ruined not by septic shock or noncompliant parents but by cross-cultural misunderstanding”

Lia’s condition was caused less by her disease but more by failures in communication and cultural understanding (doctors viewed parents as “noncompliant”, different ideas of healing, language barriers leading to misunderstandings)

chapter 14: the melting pot

Hmong resettlement in America and challenges of assimilation

Hmong did not assimilate because they wanted to preserve their culture

title is ironic because Hmong culture remained distinct instead of “melting” into American society

chapter 15: gold and dross

reflection of Lia’s condition

separating what was valuable (gold) and harmful (dross) in her medical care

chapter 16: why did they pick Merced?

why Hmong refugees settled here and how the community developed

once their community formed, others came because they want to live with people who share their culture (birds of a feather, flock together)

chapter 17: the eight questions

refers to Arthur Kleinman’s 8 questions and how they can improve communication and understanding of culture between healthcare and patients

these could have improved communication between Lia’s family and doctors

chapter 18:the life or the soul

debate on whether Lia’s outcome resulted from medical complications or cultural misunderstandings

doctors focused on saving Lia’s physical life but her parents believe saving her soul was equally important.

questions whether preserving the body is enough if cultural and spiritual needs are ignored?

chapter 19: the sacrifice

Hmong healing traditions and the importance of spiritual sacrifice to restore health and balance

restored Lia’s soul

symbolizes the many sacrifices made by her parents, doctors and ultimately Lia as a result of the cultural conflict between the family and the doctors

key concepts from the book

cultural misunderstanding

language barriers

lack of cultural competency in healthcare

disparities in access to healthcare

ethical dilemmas

stereotyping and prejudic

systemic issues

lack of empathy and empowerment