Audit of Clinical Services

Assessment of Organizational Cultural Competence

Our program is undertaking an effort to identify our organization’s strengths and needs for further training and program development to become a more culturally competent organization. As a member of this program, your input into the assessment of our organization’s cultural competence is important.

Your responses will be held in strictest confidence and will be anonymous. The results of this survey will be utilized in aggregate and summary form only. If you have questions about the assessment of organizational cultural competence, please contact (name of the individual who will be coordinating this effort) ______________________________. When you have completed the assessment, place it in (mail-box or location) ______________________________. Thank you for your assistance in this most important effort toward becoming a culturally competent program.

Please check below which of the following BEST describes your MAJOR function in the organization. CHECK ONLY ONE

Administration Clinical services Research

Support Services Education/training Student/Trainee

Advisory Board Technical assistance/Consultant

Community/continuing education

Other Please specify:

Please indicate the length of involvement with this organization:

Less than 1 year 1 to 5 years More than 5 years

Please check the ONE answer that BEST DESCRIBES your response to each of the statements.

A. Organization	YES	NO	Don’t Know
1. Cultural competence is included in the mission statement, policies, and procedures.
2. A committee/task force/program area addresses issues of cultural competence.
3. Partnerships with representatives of ethnic communities actively incorporate their knowledge and experience in organizational planning.
4. The organization supports involvement with and/or utilization of the resources of regional and/or national forums that promote cultural competence.

B. Administration	Almost Always	Often	Sometimes	Almost Never	Don’t Know
1. Personnel recruitment, hiring, and retention practices reflect the goal to achieve ethnic diversity and cultural competence.
2. Resources are in place to support initial and ongoing training for personnel to develop cultural competence.
3. Position descriptions and personnel performance measures include skills related to cultural competence.
4. Participants for all advisory committees and councils are recruited and supported to ensure the diverse cultural representation of the organization’s geographic area.
5. Personnel are respected and supported for their desire to honor and participate in cultural celebrations.
6. Fiscal resources are available to support translation and interpretation services.

C. Clinical Services IMPORTANT: If your organization does not provide these services, please check here and proceed to the next Section. _____	Almost Always	Often	Sometimes	Almost Never	Don’t Know
1. Clinical services are routinely and systematically reviewed for methods, strategies, and ways of serving consumers and their families in culturally competent ways.
2. Cultural bias of assessment tools is considered when interpreting of the results and making recommendations.
3. Translation and interpretation assistance is available & utilized when needed.
4. Forms of communication (reports, appointment notices, telephone message greetings, etc.) are culturally and linguistically appropriate for the populations served.
5. Pictures, posters, printed materials and toys reflect the culture and ethnic backgrounds of the consumers and families served.
6. When food is discussed or used in assessment or treatment the cultural and ethnic background of the consumer and family is considered.

D. Research and Program Evaluation: IMPORTANT: If your organization is not involved in these activities, please check here and proceed to the next Section. _____	Almost Always	Often	Sometimes	Almost Never	Don’t Know
1. Input on research priorities is sought from consumers and/or their families representing diverse cultures.
2. Research projects include subjects of diverse cultures representative of the targeted research population.
3. The researchers include members of the racial/ethnic groups to be studied and/or individuals who have acquired knowledge and skills to work with subjects from those specific groups.
4. Consumers and families representing diverse cultures provide input regarding the design, methods, and outcome measures of research and program evaluation projects.

E. Technical Assistance/Consultation IMPORTANT: If your organization is not involved in these activities, please check here and proceed to the next Section. _____	Almost Always	Often	Sometimes	Almost Never	Don’t Know
1. Technical assistance/Consultation activities are routinely and systematically reviewed for methods, strategies, and ways of serving communities in culturally competent ways.
2. When assessing the need for technical assistance/consultation in communities, input from members reflecting the diverse cultural make-up of these communities is sought and utilized.
3. Efforts are made to involve consultants who have knowledge of and experience with the cultural group requesting the technical assistance/consultation.
4. Evaluation from the recipients of technical assistance/consultation activities includes components of cultural competence.

F. Education/Training IMPORTANT: If your organization is not involved in these activities, please check here and proceed to the next Section. _____	Almost Always	Often	Sometimes	Almost Never	Don’t Know
1. Trainees/students are actively recruited from diverse cultures.
2. Trainees/students from diverse cultures are mentored.
3. Representatives of the diverse cultures are actively sought to participate in the planning and presentation of training activities.
4. The training curriculum and activities incorporate content for the development of cultural competence.
5. The training curriculum, materials and activities are systemically evaluated to determine if they achieve cultural competence.

G. Community/Continuing Education IMPORTANT: If your organization is not involved in these activities, please check here __________.	Almost Always	Often	Sometimes	Almost Never	Don’t Know
1. Participants are actively recruited from diverse cultures.
2. Representatives of diverse cultures are actively sought to participate in the planning and presentation of these activities.
3. The content and activities are culturally and linguistically appropriate.
4. Participant evaluation of community/continuing education activities includes components of cultural competence.

Adapted in part from Promoting Cultural Diversity and Cultural Competency Self Assessment Checklist for Personnel Providing Services and Support to Children with Special Health Needs and Their Families by Tawara D. Goode, Georgetown University Child Development Center, and Policy Brief 1: Rationale for Cultural Competence in Primary Health Care, developed by Elena Cohen, Consultant, and Tawara D. Goode, and Policy Brief 2: Linguistic Competence in Primary Health Care Delivery Systems: Implications for Policy Makers, developed by T. Goode, S. Sockalingum, M. Brown, and W. Jones, National Center for Cultural Competence, Georgetown University Child Development Center.

Respondent Information

Before completing this question, please review the statements on Assessment of Individual Cultural Competence. After reflecting upon the entire survey, please describe the subjects or topics you would like cultural competence training in:

1. __________________________________________________________________________

2. __________________________________________________________________________

3. __________________________________________________________________________

The data on this sheet are collected to obtain information about the survey respondents. This information will allow us to determine if all groups have been represented.

Your information will not be shared with anyone in the organization. This information will not be linked to your responses on the other pages.

PLEASE PROVIDE THE FOLLOWING INFORMATION by using a check mark.

Gender: Female Male

Age: 18-35 36-49 50-65 65+

Do you have a disability? `` Yes No

Are you a family member of a person with a disability? Yes No

Please indicate your racial/ethnic identity using ONE of the categories below:

African American/Black American Indian/Native American

(including Alaskan native)

Asian Hispanic

Pacific Islander White, European, non- Hispanic

Multiethnic/Other Please specify:

Developed by the AUCD Multicultural Council

Individual Assessment of Cultural Competence

As a member of the organization, the knowledge you have of yourself and others is important and reflected in the ways you communicate and interact. This individual assessment instrument was developed to assist you in reflecting upon and examining your journey toward cultural competence.

The following statements are about you and your cultural beliefs and values as they relate to the organization. Please check the ONE answer that BEST DESCRIBES your response to each of the statements.

Individual Assessment	Almost Always	Often	Sometimes	Almost Never
1. I reflect on and examine my own cultural background, biases and prejudices related to race, culture and sexual orientation that may influence my behaviors.
2. I continue to learn about the cultures of the consumers and families served in the program, in particular attitudes towards disability; cultural beliefs and values; and health, spiritual, and religious practices.
3. I recognize and accept that the consumer and family members make the ultimate decisions even though they may be different compared to my personal and professional values and beliefs.
4. I intervene, in an appropriate manner, when I observe other staff engaging in behaviors that appear culturally insensitive or reflect prejudice.
5. I attempt to learn and use key words and colloquialisms of the languages used by the consumers and families served.
6. I utilize interpreters for the assessment of consumers and their families whose spoken language is one for which I am not fluent.
7. I have developed skills to utilize an interpreter effectively.
8. I utilize methods of communication, including written, verbal, pictures, and diagrams, which will be most helpful to the consumers, families, and other program participants.
9. I write reports or any form of written communication, in a style and at a level which consumers, families, and other program participants will understand.
10. I am flexible, adaptive, and will initiate changes, which will better serve consumers, families, and other program participants from diverse cultures.
11. I am mindful of cultural factors that may be influencing the behaviors of consumers, families, and other program participants.

Developed by the AUCD Multicultural Council
Adapted in part from Promoting Cultural Diversity and Cultural Competency Self Assessment Checklist for Personnel Providing Services and Support to Children with Special Health Needs and Their Families by Tawara D. Goode, Georgetown University Child Development Center.

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