Practicing Cultural Responsiveness in Health Care Delivery Settings

Practicing Cultural Responsiveness in Health Care Delivery Settings

Webinar Overview Overview Revisiting Stigma and its Impact on Health care Delivery Systems Center for Engaging Black MSM Across the Care Continuum (CEBACC) What We ve Been Hearing Emerging Moving Cultural Competence Forward Cultural Responsiveness Contextualization, Core Elements, In Motion Moving Forward Cultural Responsiveness: Recommendations Subsequent Webinar Series Tying it all together Q&A

Center for Engaging Black MSM Across the Care Continuum (CEBACC) Key Goals: Describe health care challenges for Black MSM Address misinformation, knowledge gaps, and ignorance among provider communities Develop skills in offering high quality and nuanced culturally responsive sexual health services

CEBACC Literature Review PubMed Medline Plus JSTOR Google Scholar OAJSE 1 st level Black MSM 2 nd level Black Males 3 rd level Blacks African American, Black, MSM, MSMW, Patient, Provider, Patient/Provider, Bisexual HIV Care, Intervention, Program

CEBACC Lit. Review Findings Interventions Disparities 8 7 Barriers to Care Disparities 20% 65% Prevention Care Access Across the Cascade

Health Care Barriers In Motion Calabrese S, Earnshaw V, Dovidio J. The Impact of Race on Clinical Decisions Related to PrEP: Assumptions About Sexual Risk Compensation & Implications for Access. AIDS and Behavior 2014 February, Volume 18, Issue 2, pp 226-240 Provider Stereotypes Failure to prescribe Provider Bias PrEP Access Barriers

Moving Cultural Competency Forward We can never become truly competent in another s culture. We can demonstrate a lifelong commitment to self evaluation and self-critique - Minkler (2005). Journal of Urban Health Cultural Competence Lifelong commitment Cultural Responsiveness

Cultural Responsiveness In Context Cultural Responsiveness Maximum Desired Outcome Life-Long Learner Model Cultural Competency Minimum Set of Standards

The Growing Need for More Are distrustful of health professionals Many ethnic minorities: Perceive health care providers to be focused on stereotypes associated with minorities See health care providers as disinterested in their needs

Cultural Responsiveness: Credo Bearing in mind that lived cultural experiences are embodied (visceral), dynamic, and nuanced. Cultural Responsiveness is a self and process-driven, lifelong commitment to a tailored, dialogue-based approach that responds to the needs being presented by the individual in front of the provider, within a contextual understanding of social/economic/political/linguistic disparities.

Goals Values Outcomes Cultural Responsiveness Create stronger, more collaborative dynamics between Black & Latino Gay men and their providers Assist providers in offering care that is not rooted in assumptions, but instead informed by each patient and their specific needs encountered. Knowledge Training Introspection Co-learning Collaboration The work is never done Successful navigation of Black & Latino gay men/msm across the care continuum Recognition, challenging, and responding to active power dynamics between patient and provider that may stand as a barrier to successful navigation of care Creating a tailored, dialogue-based approach that responds to the needs being presented by the patient to the provider at the time Empowerment of the patient/provider dynamic to lead to efficacious care for Black and Latino MSM

Introspection

A Note on Institutional Consistency Cultural Responsiveness Staff Diversity? (culture, race, ethnicity) Training Institutional process Does institutional ethos support inclusion and respect of differences? What processes/policies currently obstruct lessons learned? Use data to inform whether BGM/Latino MSM/IDUs are achieving health outcomes

Expectation Management Knowledge of mistrust concerning providers May be previous negative health care experiences Myth-bust beforehand: there is no monolithic experience Understand power dynamics at play Check your privilege at the door

Dialogue (Dual Disclosures)

Course of Care

Care Assessment Stress importance of setting and keeping follow-up visit During follow-up visits prepare prompt questions to assess gaps in care or treatment non-adherence Assess Using patient input, evaluate pros/cons, successes/challenges with current course of care With patient input, make updates (when necessary) to course of care

Course of Care (Re-Engagement) Flexibility matters! The ability to recognize what s not working and push to find something that will is key Minor changes in patient notification strategies (email, text, etc) can revolutionize patient/provider relations Get uncomfortable and follow through

Resources Towards Cultural Responsiveness NASTAD s Stigma Toolkit NASTAD s Optimal Care Checklist CEBACC CME/CNEs (Forthcoming)

Subsequent Webinar Series Title Anti-Stigma Advocacy in HIV Prevention & Care: Lessons from the Black Lives Matter & Queer Dreamers Movement Using the Sexual Health Model as a Blueprint for Appropriate Care for Black and Latino Gay Men/MSM The Power of Language & The Importance of its Appropriate Use Date & Time Monday, Dec. 14 th, 2-3 PM EST Tuesday, Jan. 12 th, 2-3PM EST Tuesday, Feb. 9 th, 2-3PM EST

THANK YOU! Justin T. Rush jrush@nastad.org Edwin Corbin-Guiterrez - ecorbin-gutierrez@nastad.org Carlos de Leon cdeleon@nastad.org