CCSAD | Culturally Competent Care is Critical as Population Diversifies

In an increasingly diverse society, it is imperative for practitioners to make a concerted effort to understand patients’ background, values and beliefs, presenters Jessica Isom, MD, MPH, and Zina Rodriguez, MSW, CDE, told Cape Cod Symposium on Addictive Disorders attendees on Wednesday.

“We cannot rely on our own lens,” Rodriguez said. “It’s really on the lens of people’s lived experiences. The individuals we treat, we need to see them through their own lived experience and how they see each other.”

In the opening keynote session, Isom, a community psychiatrist, racial justice and racial equity advocate, and founder of Vision for Equity, and Rodriguez, a social worker, mental wellness advocate CEO of the diversity, equity and inclusion-focused firm Z & D Consulting, discussed keys for presenting culturally competent treatment for persons of color.

The United States population continues to become more racially and culturally diverse; by 2044, the majority of the nation will be minority individuals, Rodriguez said. In the meantime, COVID, racism and economic challenges have created a “triple threat on mental health and substance use” with Black, indigenous and people of color (BIPOC) communities being disproportionately affected. About 90% of Black and Hispanic individuals over the age of 12 with a substance use disorder do not seek treatment. Rodriguez said that those racially and ethnically diverse clients who do seek care, about 50% end treatment after 1 visit, according to SAMHSA data.

Building trust between patients and practitioners starts with building understanding, Isom said.

“That understanding requires us to be curious, which means we have to ask questions, not make assumptions and really explore,” Isom said. “That’s what cultural competence includes. It’s based on foundations of understanding you have your own expectations and attitudes, and so do other people. We’re trying to exchange information with people we’re working with to get a sense of cultures other than our own, but also to understand our own culture. Others’ observations can give us more information about our own culture than our own awareness.”

Culture is not a monolith, Isom said. It is important to avoid generalizations because individuals can identify with multiple cultures or cultures within cultures. Many variables influence culture and cultural identity.

“You have to dive deeper,” Isom said.

One tool for doing that is using culturagram, a family assessment tool that guides caregivers through a series of categories to discuss with patients to better understand their background and beliefs. The culturagram identifies:

• Reasons for relocation/migration
• Legal and socioeconomic status
• Time in community
• Language spoken at home and in community
• Health beliefs and beliefs about drug and alcohol use
• Impact of trauma, substance abuse other crisis events
• Experiences with oppression and discrimination
• Religious and cultural institutions, food, clothing, holidays
• Values about education and work
• Value about structure, power, myths and rules

“You might find that the more you ask about these topics, the more you learn about your own culture,” Isom said. “There might be assumptions you have about how everyone understands power or rules, and you might be surprised to find there is a lot of diversity there.”

When striving to provide culturally competent care, Isom recommends focusing on these basics:

• Know and understand your biases
• Do your homework and understand how your own culture differs from others’
• Create an environment of belonging by removing elements of ethnocentrism in your practice
• Be flexible in designing treatment plans to meet client needs
• Use a culturagram for mapping the role of culture
• Draw upon institutions and resources of clients’ cultural community, including churches, spiritual ceremonies, family and identity groups

“All of these things can give us more information from the community itself about the best way to approach patients’ needs,” Isom said.