Lobby
Are you currently a member of a substance misuse prevention coalition? If yes, in what state or jurisdiction?
Disclaimer
The views expressed in this webinar do not necessarily represent the views, policies, and positions of the Substance Abuse and Mental Health Services Administration or the U.S.
Department of Health and Human Services.
This webinar is being recorded and archived, and will be available for viewing after the webinar. Please contact the webinar facilitator if you have any concerns or questions.
Purpose of the PTTC
•Develop and disseminate tools and strategies needed to improve the quality of substance abuse prevention efforts
•Provide training and learning resources to prevention professionals
•Develop tools and resources to engage the next generation of prevention professionals
Pacific Southwest (HHS Region 9) PTTC
CA
NV
AZ
HawaiiAmerican Samoa
Guam
Palau
Northern Mariana Islands
MarshallIslands
Micronesia
Parent Organization: CASAT, University of Nevada, Reno
Mark Your Calendars!Two-part webinar series on sustaining substance misuse prevention outcomes:
PART ONE:August 20th at 3:00 PM Pacific Time
The Prevention Coalition’s Role in Addressing Health DisparitiesAlbert Gay, MSJune 26, 2019
Albert Gay, M.S. is a national trainer and consultant in the field of substance use prevention. Over the years, he has worked on many federal level projects for the Substance Abuse and Mental Health Services Administration (SAMHSA). Currently, he works within Indiana University’s School of Public Health as an Education and Training Specialist and Research Associate. Nationally, he has trained the behavioral health workforce, the United States military, and diverse population groups and community coalitions within a collaborative strategy framework. Currently, he is the chair of a local coordinating council for the county and a key leader for the Gary Drug Free Communities coalition.
Agenda
• Coalitions• Systems• Cultural Competence Continuum• CLAS Standards• Public Health Approach• Strategic Prevention Framework• MAPP IT Process
Coalitions
CADCA defines coalitions as the following:• A formal arrangement for collaboration between groups or sectors of a
community, in which each group retains its identity, but all agree to work together toward a common goal of building a safe, healthy, and drug-free community.
Power at the Table
State, local, tribal
MediaBusiness
Schools
Law EnforcementParents
YouthOther
Coordinator
Youth-serving Orgs.
Healthcare
Civic/ Volunteer
Religious/ Fraternal
A Coalition Is…
• A diverse group of individuals and agencies with deep connections to the local community
• A group that serves as a catalyst for the goal of community change A group that adapts, creates, or develops public policy
• A group that influences population behavior • A group that works to create a healthy community
A Coalition Is… (cont’d)
• A partnership of the many sectors of a community which gather together collaboratively to solve the community’s problems
• A group that guides the community’s future • A group that is driven by citizen-identified issues
Here’s Why Coalitions Form
• To respond to an urgent situation that demands action• To control the future of the community• To acquire and/or provide services• To deliver effective and efficient practices, policies, and
programs • To facilitate communication among groups• To strategically plan community-wide initiatives• To foster leverage within the community• To create and sustain social change
Here’s What Coalitions Do
• Connect with their community members on a grassroots level • Use multiple strategies across multiple sectors of the
community• Solve problems collaboratively and develop a strong
community
What Makes Coalitions Perfect for Disparities Work?
• Ability to work upstream and working at root level causes• Constant surveillance (updating assessment data)• Work with Strategic Prevention Framework (SPF)• Value of Cultural Competence • Working together for leverage
Systems
Systems Change
A system is an organized entity made up of interrelated and interdependent parts
Systems Change addresses root causes of social problems
Causes (like biases) are embedded in networks
Social Determinants of Health within Systems
Life-enhancing resources whose distribution across populations effectively determines length and quality of life.
Institutions
20
Principle 1: Non-Discrimination
Prevention professionals shall not discriminate against service recipients or colleagues based on race, ethnicity, religion, national origin, sex, age, sexual orientation, education level, economic or medical condition, or physical or mental ability. Prevention professionals should broaden their understanding and acceptance of cultural and individual differences and, in so doing, render services and provide information sensitive to those differences.
Principle 2: Competence
Prevention professionals shall master their prevention specialty’s body of knowledge and skill competencies, strive continually to improve personal proficiency and quality of service delivery, and discharge professional responsibility to the best of their ability. Competence includes a synthesis of education and experience combined with an understanding of the cultures within which prevention application occurs. The maintenance of competence requires continual learning and professional improvement throughout one’s career.
Principle 4: Nature of ServicesPractices shall do no harm to service recipients. Services provided
by prevention professionals shall be respectful and non-exploitive. a) Services should be provided in a way that preserves and supports the strengths and protective factors inherent in each culture and individual. b) Prevention professionals should use formal and informal structures to receive and incorporate input from service recipients in the development, implementation and evaluation of prevention services. c) Where there is suspicion of abuse of children or vulnerable adults, prevention professionals shall report the evidence to the appropriate agency.
Principle 5: Confidentiality
Confidential information acquired during service delivery shall be safeguarded from disclosure, including - but not limited to - verbal disclosure, unsecured maintenance of records or recording of an activity or presentation without appropriate releases. Prevention professionals are responsible for knowing and adhering to the State and Federal confidentiality regulations relevant to their prevention specialty.
Principle 6: Ethical Obligations
According to their consciences, prevention professionals should be proactive on public policy and legislative issues. The public welfare and the individual’s right to services and personal wellness should guide the efforts of prevention professionals to educate the general public and policy makers. Prevention professionals should adopt a personal and professional stance that promotes health.
Cultural Competence Continuum
Cultural Destructiveness
Cultural Incapacity
Cultural Blindness
Pre-Cultural Competence
Cultural Competence
Cultural Proficiency
1. Cultural Destructiveness• Attitudes, policies and practices which are
destructive to cultures and individuals within them• Purposeful destruction of a culture• Assumes one race superior• Dehumanization of specific cultures or individuals
signifying an underlying bias toward the superiority of the dominant or majority group.
• There is an intention to ignore issues affecting minorities and promote policies and standards that have an adverse impact on them.
• Ex: The Tuskegee Experiment.
2. Cultural Incapacity• The inability to work with diverse populations. • There is not an intention to ignore issues or promote
policies and standards that have an adverse impact on minorities; instead, their practices are based on a lack of understanding and ignorance.
• Intent not to be intentionally culturally destructive• Lack of capacity to work with minorities• Extreme bias and belief in racial superiority of dominant
group• Examples:
• 1. Not providing bilingual personnel when needed.• 2. Drawing accurate but inappropriate clinical or educational
conclusions based on the professional's view of the world, not on the child's view that may affect how he or she makes eye contact, respond to group activities.
3. Cultural Blindness• Midpoint on the continuum• Approaches used by and for the majority are perceived as
relevant for all others. Practices are adopted for "the greater good”, which is generally the majority perspective.
• Inability to examine or even recognize existing biases in approaches to practices, education, and research that perpetuates the continued existence and development of models that support stereotypes of diverse populations and thus further promotes prejudice.
• Systems/agencies provide services with philosophy of being unbiased.
• Belief that color or culture makes no difference• Belief that dominant culture approaches are universally
applicable
4. Cultural Pre-competence
• Implies movement• Weaknesses recognized in working with minorities• Attempts to improve practices and increase knowledge• Although this phase is a positive movement, false "comfort"
may set in after making only minimal efforts to be responsive to diverse populations. The efforts may only be peripheral and not sufficient to truly address cultural issues.
• Danger of tokenism
5. Cultural Competence (Basic)
• Acceptance and respect for difference• Continuing self-assessment regarding culture• Careful attention to dynamics of difference• Continuous expansion of cultural knowledge and resources• A demonstrated commitment to diverse populations in all
aspects of the structure and functions of the organization. • Characterized by a sustained, systematic integration and
evaluation at all levels of significant collaboration from diverse populations into the infrastructure of the organization.
6. Advanced Cultural Competence (Proficiency)• Culture held in high esteem• Is demonstrated by the centrality of an organization's
commitment to diversity and by its external expertise, leadership, and proactive advocacy in promoting appropriate care for diverse populations.
• Influences systems and governance• Knowledge base of cultural competence sought by
• conducting culture-based research• developing new approaches based on culture
Cultural Competence Continuum
Cultural Destructiveness
Cultural Incapacity
Cultural Blindness
Pre-Cultural Competence
Cultural Competence
Cultural Proficiency
Does Your Organization
• Conduct cultural self-assessment?• Value diversity and inclusion?• Manage the dynamics of difference?• Adapt to diversity and the cultural contexts of individuals and
communities served?• Identify cross-cultural dynamics?• Institutionalize cultural knowledge?• Respect and respond to cultural needs of clients/participants?
How Do We Acquire Cultural Competence?
• Progress along the cultural competency continuum requires a continual assessment of an organization's /one’s ability to address diversity, celebrating successes, learning from mistakes, and identifying opportunities for rediscovery.
• Recognize the broad dimensions of culture• Respect cultural stakeholders as the primary source for
defining needs and priorities• Increase sensitivity to alienating behaviors
cont.
Movement Toward Cultural Competence
• Attitudes must change to become less ethnocentric and biased.
• Policies must change to become more flexible and culturally impartial
• Practices must become more congruent with cultures
1st Steps to Readiness for Coalition Equity Work• Invite leaders or allies to share at meetings• Have some focus group• Share information on local disparities and links to SDOH (articles,
social media posts, stories from the news, etc.)• Attend cultural functions (celebrations, parades, listening sessions,
forums, places of worship, places of learning, etc.)• Highlight attention to Social Justice issues (protests, statistics,
forums)• Listen/learn from Health Equity and Social Justice groups,
workshops, conference, or other.
2Systemic BiasDiscrimination
3Ignore differencesEncourage assimilation
4
Values Diversity. Tends to tokenize
5
Exemplify cultural competenceMission statement & policies reflect respect for cultures.Recruit/hire diverse workforce
6
Systemically holds cultures in high esteem. Use as foundation. Develop organizational practices. Employ persons with expertise. Publish / use evidence‐based models. Mentor / support other organizations..Advocate for populations
Cultural Incapacity
Cultural Blindness.
Cultural Pre‐Competence
Cultural Competence
Cultural Proficiency
Cultural Destructiveness
Destructiveto cultural groups
1
Cultural Competence Continuum
CLASStandards
Mission
Quality of Care
Demographic Changes
LegislationAccreditation
Reducing Litigation
Access to Care
The National Standards for Culturally and Linguistically Appropriate Services (CLAS)
• CLAS were designed by the Office of Minority Health within the U.S. Department of Health and Human Services.
• CLAS Standards address health disparities by providing guidelines for organizations to advance health equity by implementing culturally and linguistically appropriate services.
• The language focuses on health care, but SAMHSA promotes the use of the CLAS Standards for substance abuse prevention efforts.
Department of Health and Human Services, 2015
Policy / Enforcement
Buy-in / Outcomes
Practice / Culture
Governance, Leadership,
and Workforce (Standards 2-4)
Communication and Language
Assistance (Standards 5-8)
Engagement, Continuous
Improvement, and
Accountability (Standards 9-15)
PrincipalStandard
1
Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.
• Identify and develop informed and committed champions of cultural competency throughout the organization in order to focus efforts around providing culturally competent care.
• Ensure that a commitment to culturally competent care is reflected in the vision, goals, and mission of the organization and couple this with an actionable plan.
• Implement strategies to recruit, retain, and promote at all levels of the organization a diverse leadership that reflects the demographic characteristics of the populations in the service area.
• Develop, maintain, and promote continuing education and career development opportunities so all staff members may progress within the organization.
• Conduct ongoing assessments on the demographics of your community to ensure you are providing appropriate services.
• Offering language assistance• Offering services in languages other
than English• Translating documents into
languages other than English• Ensure that the literacy level of your
audience is reflected in your communications (verbal & written).
• Create policies to ensure that language and cultural considerations are addressed and monitored.
• Make sure that your coalition is representative of your community.
• Promote mentoring opportunities.• Create a feedback loop for clients to
tell their honest experience with organization.
CLAS Examples
The Public Health Approach is Coalition Work
Define Problem Identify Risk / Protective Factors
Select Interventions
Program Implementation /
Evaluation
The Framework
Coalitions Use the Strategic Prevention Framework Assessment
Profile population needs, resources, and readiness to address needs and gaps
CapacityBuild capacity to address needs
PlanningDevelop a Comprehensive Strategic Plan
ImplementationImplement evidence-based prevention programs and activities
EvaluationMonitor, evaluate, sustain, and improve or replace those that fail
CLASStandards
Strategic Prevention Framework Tool
ASSESSMENT• Ensure that data is culturally responsive and appropriate
• Use a culturally competent evaluator for assessment
• Gain approval of the community for data collection and analysis
• Create a process for identifying culturally relevant risk and protective factors and other underlying conditions
• Formulate culturally-based assumptions of change (Identify change from the community’s perspective)
• Assesses organization diversity
CAPACITY•Develop policies, procedures, and resources that facilitate the ongoing development of cultural competence and inclusion
• Willing to commit the resources necessary to build or strengthen relationships with groups and communities
• Learn to be an ally to groups that experience prejudice and discrimination in the community. Help others learn to be an ally to their own cultural groups
PLANNING• Make sure the community is represented in the planning process
• Identify mutually acceptable goals and objectives
• When selecting programs and strategies, consider their fit with:• Community culture• Existing prevention efforts• Past history
IMPLEMENTATION• Encourage and accommodate a variety of learning and participation styles, building on community members’ strengths.
• Community has opportunity to create and/or review audiovisual and printed materials, to ensure they are accessible to, and attuned to their community or focus population.
EVALUATION• Ensure that data collection tools reflect community culture
• Use a culturally competent evaluator for evaluation
• Obtain permission to disseminate the evaluation findings from the organization or entity implementing the intervention
• There is a regular forum for a wide variety of community members to provide both
• formal and informal feedback on the impact of interventions in their community
Leverage is the Name of the Game
• Controlling the course of the community• Transforming systems• Altering the historic course of outcomes
Systems Change
Risk & Protection
Poverty
Neighborhood Attachment Poverty
NEIGHBORHOOD ATTACHMENT!!!!!
Substance Misuse, Risk / Protection & Social Determinants of Health• Coalition’s priority
substances?• Priority risk/protective factors?• In which SDOH are they
found?
Recruitment of Community Resources for SDOH
• Identify key leaders within each sector• Notoriety • Outcomes • Passion• Decision makers/ influencers• Culturally Competent Approach • Shared interests/values/goals• Culturally Responsive• Clear responsibilities• How coalition benefit sector• Positive outcomes (Win – Win)
Where Are Those Resources Found Within The Community?
• Religions/FBO• Fraternal • Civic/Volunteer • Healthcare Field• Government• Other Organizations• Champions
• Youth• Parents• Businesses• Media• Schools• Youth Servicing
Orgs• Law Enforcement
MAPP – The Public Health Infrastructure
National Association of County Health Officials
MAPP - Mobilizing for Action through Planning and Partnerships
1. Organize for Success 2. Visioning 3. Four
Assessments
4. Identify Strategic Issues
5. Formulate Goals &
Strategies6. Action
Cycle
1. Organize for Success & Partnership Development1. Determination of necessity of undertaking2. Identify and organize participants (key stakeholders)3. Design of planning process4. Assess project resource needs (meeting space, travel, etc.)5. Conduct Readiness Assessment for planning process6. Determine how process will be managed
2. Visioning
1. Identify other visioning efforts 2. Design visioning process / select facilitator3. Conduct visioning process4. Formulate the vision statement / common values
3. Collecting and Analyzing Data
The Four Assessments• Community Themes and Strengths • Local Public Health System• Community Health Status• Forces of Change
4. Identify and Prioritize Strategic Issues
1. Identify potential strategic issues from 4 assessments2. Understand why certain issues are strategic 3. Determine consequences of not addressing certain issues4. Consolidate overlap and related issues for manageability5. Prioritize issues and consider relation to one another
5. Develop, Goals, Strategies, and Action
1. Develop goals related to vision and strategic issues2. Generate strategy alternatives to address goals/vision3. Consider barriers to implementation (resources, support, etc.)4. Explore implementation details (who, when, resource needs)5. Select strategies from among list and begin processes6. Draft and adopt planning report
Planning
ImplementationEvaluation
Planning1. Organize for action2. Develop measurable objectives3. Develop action plans
• Implementation1. Review action plans/
coordinate resources2. Implement and monitor action
• Evaluation1. Engage stakeholders to
prepare for evaluation2. Focus evaluation design3. Gather credible evidence4. Ensure evaluation results are
used and shared with others.
6. Taking and Sustaining Action
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