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Rationale for Self-Assessment

Happy KidsHealth and human service organizations are recognizing the need to enhance services for culturally and linguistically diverse populations. Assessing attitudes, practices, policies and structures of administrators and service providers is a necessary, effective and systematic way to plan for and incorporate cultural competence within an organization. Determining the needs, preferences and satisfaction of family members/consumers is an essential aspect of this process. The Maternal and Child Health Bureau (MCHB), through its Title V - Children With Special Health Care Needs programs (CSHCN), supports self-assessment as a tool that assists with the development of State Block Grant applications. The MCHB also emphasizes self-assessment as a key strategy to address Goal III, Objective 3.9 To increase the percentage of states that implement culturally competent policies, practices and procedures to 100%.

Essential Elements in Achieving Cultural Competence

The National Center for Cultural Competence (NCCC) embraces a conceptual framework and model for achieving cultural competence adapted from the work of Cross et al., 1989. Cultural competence requires that organizations and their personnel have the capacity to: (1) value diversity, (2) conduct self-assessment, (3) manage the dynamics of difference, (4) acquire and institutionalize cultural knowledge, and (5) adapt to the diversity and cultural contexts of the individuals and communities served. Consistent with this framework, a major focus of the NCCC is the provision of technical assistance to conduct self-assessment within health care and human service agencies. The focus includes the development of assessment instruments and processes for both organizations and individuals.

The Benefits of Self-Assessment

The NCCC supports the concept that cultural competence is a developmental process and evolves over an extended period. Both organizations and individuals are at various levels of awareness, knowledge and skill acquisition along the cultural competence continuum. The capacity to engage in self-assessment helps organizations to:

  • gauge the degree to which they are effectively addressing the needs and preferences of culturally and linguistically diverse groups;
  • establish partnerships that will meaningfully involve families/consumers and key community stakeholders;
  • improve family/consumer access to and utilization of services and enabling supports;
  • increase family/consumer satisfaction with services received;
  • strategically plan for the systematic incorporation of culturally and linguistically competent policies, structures and practices;
  • allocate personnel and fiscal resources to enhance the delivery of services and enabling supports that are culturally and linguistically competent; and
  • determine individual and collective strengths and areas for growth.

There are numerous benefits to self-assessment. Such processes can lead to the development of a strategic organizational plan with clearly defined short-term and long-term goals, measurable objectives, identified fiscal and personnel resources, and enhanced consumer and community partnerships. Self-assessment can also provide a vehicle to measure outcomes for personnel, organizations, population groups and the community at large. The NCCC views self-assessment as an ongoing process, not a one-time occurrence. It offers organizations and their personnel the opportunity to assess individual and collective progress over time.

The NCCC's Values and Guiding Principles of Self-Assessment

The NCCC uses a set of values and principles to guide all of the self-assessment activities including the development of knowledge and products, dissemination, and the provision of technical assistance and consultation.

  • Self-assessment is a strengths-based model.

The purpose of self-assessment is to identify and promote growth among individuals and within organizations that enhances their ability to deliver culturally and linguistically competent services and supports. Self-assessment emphasizes the identification of strengths, as well as areas of growth, at all levels of an organization. The process also allows organizations to identify and acknowledge the internal strengths and assets of personnel that in many instances are inadvertently overlooked.

  • A safe and non-judgmental environment is essential to the self-assessment process.

Self-assessment is most productive when conducted in an environment that: (1) offers participants a forum to give honest statements of their level of awareness, knowledge and skills related to cultural and linguistic competence; and (2) provides an opportunity for participants to share their individual perspectives in a candid manner; and (3) assures information provided will be used to effect meaningful change within the organization. The NCCC embraces the concept that cultural competence is developmental and occurs along a continuum (Cross et. al.) It matters not where an individual or organization starts, as long as there is continued progression towards the positive end of the continuum.

  • A fundamental aspect of self-assessment assures the meaningful involvement of consumers, community stakeholders and key constituency groups.

Principles of self-determination and cultural competence assure that consumers are integrally involved in processes to plan, deliver, and evaluate services they receive. These principles extend beyond the individual to the community as a whole. Self-assessment must solicit and value the experiences and perspectives of consumers and families who receive services. Similarly, opinions should be sought from key stakeholders and constituency groups within the broad integrated service delivery system. An inclusive self-assessment process can forge alliances and partnerships that have long-lasting benefit for the organization and the larger community.

  • The results of self-assessment are used to enhance and build capacity.

The intent of the self-assessment process is neither to render a score or rating nor to label an individual or an organization. Rather, it is intended to provide a snapshot as to where an individual or organization is at a particular point in time. Results should be used to strategically plan long- and short- term objectives to enhance the organization s capacity to deliver culturally and linguistically competent services at all levels within the organization, including: policy makers, administrators, providers, subcontractors and consumers at both the state and local level. The NCCC s experiences with self-assessment have demonstrated that comparisons between professionals and among organizations are of little benefit. Greater benefit is derived from individual and organizational self-comparison over extended periods of time to ascertain the extent to which growth has occurred.

  • Diverse dissemination strategies are essential to the self-assessment process.

Self-assessment results should be shared with participants and key stakeholders in a manner that meets their unique needs. The NCCC has employed an array of dissemination strategies that are tailored to the specific interests of the participating organization. This involves identification of the audiences and the presentation of the data in formats that are most useful and accessible. Additionally, this recognizes that the need for information will vary for policy makers, administrators, service providers, consumers and other stakeholders. Examples include but are not limited to:

  • comprehensive reports and executive summaries
  • Power Point presentations
  • conference calls
  • on-site program and workgroup consultations
  • Town Hall style meetings
  • strategic planning sessions

The NCCC has provided linguistic and sign language interpretation services and translation of materials that respond to the needs of varied constituency groups. These strategies demonstrate an understanding of and respect for the diverse communication and learning styles among individuals and groups.

Useful Steps for Planning and Implementing Self-Assessment

The process of self-assessment is as important as the outcome. The NCCC has found the following steps to be very beneficial to the self-assessment processes it has conducted with seven State Title V MCH/CSHCN programs.

  • Cultivating Leadership.

It is incumbent upon leadership to establish a rationale for and to promote self-assessment as an organizational goal and priority. Cultivating leadership, in this instance, would encompass identifying members from all strata of an organization to fulfill leadership roles in the self-assessment process. Effective leadership usually involves relinquishing or sharing power at many levels (Mahan, 1997). An emphasis should be placed on encouraging personnel to assume leadership roles at all levels of the organization. Shared power is an integral principle of leadership development (Kouzes & Posner, 1990; Covey, 1996; Melaville & Blank, 1991; Lipman-Blumen, 1996).

  • Getting Buy-In.

Establish a shared vision that conveys the importance of the self-assessment process to the overall organization, its personnel, the families/consumers and communities served. Sharing a view of the future represents the most important context for effecting change (Roberts & Magrab, 1999). When individuals are involved in the generation and use of knowledge this enables different groups of people to act collectively based on informed decisions (Selener, 1990). A major benefit is the formation of a coalition of stakeholders, who are informed and prepared to affect and sustain change to improve the delivery of services and enabling supports.

  • Assuring Community Collaborations & Partnerships.

A major principle of cultural competence involves working in conjunction with natural, informal, support and helping networks within diverse communities (Cross et al., 1989). From the inception of the self-assessment process, include community partners and key stakeholders in meaningful ways. Some examples are developing a shared vision, identifying leadership roles and responsibilities, distributing tasks equitably based on capacity, and allocating resources. It is important to recognize that individuals and groups will choose different levels of involvement and ways to participate. This may vary from serving on task forces or workgroups, participation in focus groups, making in-kind or other fiscal contributions, sub-contracting for specific services to providing meeting facilities and other accommodations. It is an essential to demonstrate that the contributions of each community partner are valued and respected.

  • Structuring Support for the Process.

Convene a committee, work group or task force that will assume responsibility for the self-assessment process. The group should have representation from policy making, administration, service delivery, consumers and other community stakeholders. It should also reflect the diversity of the organization and the community at large. This group is the primary entity for planning and implementing the self-assessment process, and should have ready access to decision makers or have the ability to make decisions.

  • Allocating Personnel and Fiscal Resources.

Conducting a self-assessment process is resource intensive. It requires a dedicated budget and level of effort for organizational personnel. This may also extend to community partners and key stakeholders involved in the process. Budgetary considerations may include subcontracts for the self-assessment process such as consultants/facilitators, meeting or conference facilities, and interpretation and translation services. There may be other associated costs for: stipends/honoraria for consumer participation and family supports; local/domestic travel reimbursement; and printing, mailing and other dissemination activities. Consideration should be given to the necessary level of effort for personnel who have responsibility for this process. This will entail delineating responsibilities and determining the duration and intensity of time required for personnel. It may require deferment or reassignment of current workload/duties. The self-assessment process depends on a well-crafted allocation of personnel and fiscal resources.

  • Managing Logistics.

The ability to effectively coordinate numerous logistical tasks is vital to the self-assessment process. The task force or workgroup needs to insure sufficient time to plan and prepare, timely dissemination of information to all involved and the development of a calendar and schedule of activities (e.g. sites and times for regular meetings, teleconferences, focus groups, administering the self-assessment instrument, data collection and analysis and dissemination of results).

  • Analyzing and Disseminating Data.

The active involvement of individuals, groups and communities is a highly valued and integral aspect of the self-assessment process. Task force and workgroup members need to plan their involvement in data collection (Census and program needs assessment data blended with the data from the self-assessment), analysis, interpretation, presentation and dissemination. This approach is commensurate with culturally competent and participatory action designs in research and evaluation (Brandt, 1999; Caldwell, et al, 1999; Goode & Harrison, 2000).

  • Taking the Next Steps.

The self-assessment process can yield a wealth of information about organizational strengths and areas for growth. Careful consideration should be given to:

  • establishing organizational priorities
  • developing a strategic plan with goals and objectives to sustain strengths and address growth areas
  • allocating necessary resources to accomplish strategic plan goals
  • sustaining and maintaining partnerships with community stakeholders
  • incorporating self-assessment results into the state block grant planning and development process.

The self assessment process may lead to changes in: organizational mission, policies, structures and procedures; staffing patterns; position descriptions and personnel performance measures; delivery of service and supports; outreach and dissemination approaches; composition of advisory boards and committees; professional development and inservice training activities; and management and information systems (MIS) and telecommunication systems. Achieving cultural competence is a long-term commitment. Remember that it is accomplished one step at a time.

The NCCC operates under the auspices of Cooperative Agreement # U93-MC-00145-06 and is supported in part from the Maternal and Child Health Program (Title V, Social Security Act), Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS).

References

Brant, J. et al., Oncology nursing society multicultural outcomes: Guidelines for cultural competence (USA: The Oncology Press, 1999.)

Caldwell, C., Jackson, K., Tucker, B., and Bowman, P. (In press). Culturally Competent Research Methods in African American Communities: An Update.

Advances in African American Psychology: Theory, Paradigm Methodology, and Reviews, ed. R.L. Jones. Hampton, VA: Cobb and Henry Publishers.

Covey, S. (1996). Three roles of the leader in the new paradigm. The leader of the future: New visions, strategies and practices for the new era. In Hesselbein, F., Goldsmith, M., & Beckhard, R. (Ed.) San Francisco: Jossey-Bass.

Cross, T., Bazron, B., Dennis, K., and Isaacs, M. (1989). Towards a culturally competent system of care volume I. Washington, D.C.: Georgetown University Center for Child and Human Development (aka Georgetown University Child Development Center), CASSP Technical Assistance Center.

Goode, T. & Harrison, S. (2000). Policy brief 3:Cultural competence in primary health care: Partnerships for a research agenda. Washington, D.C.: Georgetown University Center for Child and Human Development (aka Georgetown University Child Development Center).

Kouzes, J. M. & Posner, B.Z. (1990). The leadership challenge. San Francisco: Jossey-Bass.

Lipman-Blumen, J. (1996). The Connecting edge: Leading in an independent world. San Francisco: Jossey-Bass.

Magrab, P.R. (1999). The meaning of community. In Roberts, R. N. & Magrab, P.R. (Eds.), (pp. 3-29). Where children live: Solutions for serving children and their families. Stamford, CT: Ablex Publishing.

Mahan, C. (1997). Surrendering control to the locals. Journal of Public Health Management and Practice, Vol. 3(1).

Mason, J. (1996). Cultural competence self-assessment questionnaire. Portland, Oregon: JLM & Associates.

Melaville, A. & Blank, M. (1991). What it takes: Structuring interagency partnerships to connect children and families with comprehensive services. Washington, D.C.: Education and Human Services Consortium.

Selener, D. (1990). Participatory Evaluation. People s knowledge as a source of power. Networking Bulletin.

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