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Rationale for Self-Assessment
 Health 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.
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).
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.
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).
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).
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