"Capacity Building and Cultural Competence
  When Working with Minority Populations"

NCDDR Webcast #4
November 16, 2006, 2:00-3:25 PM CST
Presenters: Dr. Fabricio E. Balcazar
Dr. Yolanda Su‡rez

Edited Transcript

>> Joann Starks: Good afternoon, everyone. And thank you for joining the webcast 
on "Capacity Building and Cultural Competence When Working with Minority 
Populations." My name is Joann Starks, and I'm with the National Center for the 
Dissemination of Disability Research, or NCDDR, based at the Southwest 
Educational Development Laboratory in Austin, Texas. I'll be moderating today's 
webcast and getting your questions to our presenters. Co-hosting todayÕs webcast 
is Frank Martin who is also with the NCDDR. Before we move on to the introduction 
of todayÕs presenters, I want to be sure to thank our partners at ILRU in Houston, 
for helping with the technical side of the webcast.

There are some materials accompanying today's webcast that can be found on 
ILRU's Web site. These include a PowerPoint(TM) file with a corresponding 
Word(TM) version for accessibility. 

You can submit questions at any time during the webcast, and the presenters will 
answer them at the end, where we have set aside a question and answer period, 
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Now, I would like to turn things over to Frank Martin, who will introduce todayÕs 
guest presenters. Frank--

>>Frank Martin: Thank you Joann. The NCDDR is pleased to bring you today's 
webcast on the topic of Capacity Building and Cultural Competence when Working 
with Minority Populations. 

TodayÕs topic is important for many reasons. At a foundational level, many 
scholars and consensus reports have suggested that African American, Hispanic-
Latino, Asian, Asian-Pacific Islander, and Native American populations are 
frequently underrepresented in the planning, conduct, dissemination and outreach 
of disability and rehabilitation research activities. Many authors believe that 
researchers and outreach planners can improve the likelihood of success by 
gaining knowledge of cultural groups, their histories, and strategies for perceiving 
the world.

Today, we are privileged to have as our presenters, two NIDRR-sponsored 
researchers with experience in this topical area. They are Dr. Fabricio Balcazar 
and Dr. Yolanda Su‡rez. Drs. Balcazar and Su‡rez are both professors at the 
University of Illinois at Chicago.

Dr. Balcazar has conducted research over the past 25 years on the development of 
systematic approaches for promoting the empowerment of minorities and under-
served populations, including Latinos with disabilities and their families. He is 
currently the director of the NIDRR-funded Center for Capacity Building on 
Minorities with Disabilities Research and has been actively engaged in the 
development and dissemination of cultural competence trainings for researchers 
and service providers. 

Dr. Yolanda Su‡rez is a Professor and Head of the Department of Occupational 
Therapy at the University of Illinois at Chicago. Her research interests and 
expertise include the study of participatory and empowerment evaluation of 
community health initiatives, university-community partnerships, participatory 
needs assessment methodologies with people with disabilities and issues of 
multicultural training and diversity. She is also the Co-Director of the Center on 
Capacity Building for Minorities with Disabilities Research. 

Now, I'd like to invite Drs. Balcazar and Su‡rez to begin today's presentation.

>> Fabricio Balcazar: Thank you, Frank. It's certainly an honor to be here with you 
talking about these topics today. They are very close to our heart and our passion. I 
am going to start very briefly by providing a brief description of the Center for 
Capacity Building on Minorities with Disabilities Research and then summarize 
the steps and parts of our presentation. 

The Center's main goal is increase the capacity of community based organizations 
like Centers for Independent living and other agencies, and the state vocational 
rehabilitation agencies to document the impact of their programs and develop 
culturally competent services. The Center utilizes a participatory research 
methodology to promote organizational change. Our mission is to promote 
positive rehabilitation outcomes for minority individuals with disabilities at the 
national level. Our center staff is conducting participatory research and 
demonstration projects in collaboration with interested agencies engaging in 
active dissemination efforts and providing state of the art training and technical 
assistance on cultural competence to professionals and researchers in the field. 

This presentation will include two parts. The first part will summarize the capacity 
building activities being conducted by center staff under the direction of Dr. 
Yolanda Su‡rez. The Center utilizes a participatory program evaluation model 
which actively involves consumers and agency staff in the process of identifying 
service needs, selecting program goals, developing a logic model for success, 
and implementing and evaluating change efforts to address critical needs and to 
improve services. From this perspective, participating agencies develop their 
capacity for effectively using consumer input and program data to identify research 
questions and methods to improve services. We will summarize our progress to 
date.

The second part of the presentation will describe our conceptual framework for 
cultural competence training, review the factors that determine cultural diversity, 
and summarize our training activities in this area to date. 

Cultural diversity is constantly challenging our ability to outreach and effectively 
involve minority individuals with disabilities in our research projects and our 
services. We will discuss some of the strategies that appear to be beneficial in 
this area.

Next slide (2). The conceptual framework of the research activities and training 
activities in the Center involve capacity building for program evaluation; the 
promotion of cultural awareness, knowledge and skills; and outreach and 
dissemination activities, and they all help us improve the cultural competence of 
rehabilitation providers as well as researchers in the field. And now Dr. Su‡rez is 
going to start describing the work in capacity building.

>> Yolanda Su‡rez: Next slide, please (3). The approach that we take into capacity 
building for program evaluation, as Fabricio said, is a participatory program 
evaluation approach where we look at how to create capacity, through 
documenting the initiatives of the different centers. 

Why program evaluation? Why are we doing this work? The literature has 
highlighted that repeatedly agencies that are serving minorities with disabilities 
and agencies in general and organizations including office of vocational 
rehabilitation, independent living centers and community based organizations are 
now under a lot of pressure from funders, and communities themselves, for 
accountability. Agencies are now requested by funders to have a logic model in 
place and to have an evaluation plan in place. So, repeatedly we have had 
agencies come to us and say, "We need help with getting the evaluation 
conducted." 
 
There are a couple of other reasons that have contributed to why creating capacity 
for evaluation is very important. Agencies are being asked to do their own 
evaluation and not necessarily do they always have the time or the skills to be able 
to do it. There's a need right now from the agency perspectives, and those serving 
minorities with disabilities, for accountability. 

The research is highlighting the new data that minorities with disabilities are not 
achieving outcomes at the same rate that other minorities are. We've been working 
with agencies from vocational rehabilitation offices, community based 
organizations, and independent living centers and they are all telling us this. 
Outcomes, the achievement of outcomes for minorities with disabilities are not at 
the same rate as for other groups that they are serving. 

Next slide, please (4). So the approach that we take in capacity building for 
evaluation to meet one of these needs for the agency, to be able to document and 
also to look at how to improve the goals for outreach and services. We are using 
the participatory capacity building approach that you have in front of you and this is 
based on some of research on models proposed by the Fawcett group at the 
University of Kansas. 
 
There are 7 steps or 7 phases in the capacity building approach that we're using. 
We start working with the CBO's, the ILC's (Independent Living Centers), or VR 
offices, and looking at identification of the needs and concerns from the 
perspective of minorities with disabilities. What are some of the issues that matter 
to them? What are some of the issues that they're concerned about? What are 
some of their specific needs, and what are some of the needs to be able to 
function effectively in the community and be integrated?

The second phase is looking at specific program goals or service goals. 
 We do a lot of brainstorming as we go from step to step and then we move into 
helping them brainstorm to develop a logic model. A logic model is a visual 
display of how a program, a service, or an intervention works. What are the 
outcomes? How do we get to the outcomes? What do we want to achieve? 

The next step is we looked at the phase of identifying evaluation methods and 
strategies. Heavy emphasis is placed on how to use strategies; evaluation 
strategies and methods that the agency can use. We provide this capacity building 
for about a year or two years, but the agencies are going to be on their own and we 
gradually fade out and move to other agencies. So it is important for us to be able 
to use and encourage them to use strategies and methods that they can use on 
their own and can be maintained at the agency. 

The next phase is documenting the impact of the process and services that they 
provide and how to document the impact on minorities with disabilities. 
 We also engage in interpreting the data and reporting the data, and then a lot of 
brainstorming about how to use the data that they're gathering throughout the 
evaluation process, to improve services. The letters that you see by the different 
phases are the agencies that we're working with and where they are. 

- So, we have one agency working right now in participatory education of needs 
and concerns. 
- We have a vocational rehab.--one of the states in the midwest--is working on 
phase number 3. 
- We have an independent living center working in phase number 4. 
- We have another agency at phase number 5. 
- We have two that are at phase number 6 and two VR offices for agencies in the 
midwest working between phase 5 and 6. 

So this basically illustrates where the different agencies are. One of the key 
questions for us as researchers is "How do we know that capacity building is 
happening?" 

Next slide, please (5). The next slide looks at how are we conceptualizing capacity. 
Capacity for evaluation really involves the intersection between skills, knowledge, 
attitudes, agency policies, and application. 

When we look at attitudes about evaluation we basically ask ourselves, "What 
attitudes do staff and/or participants who are actively involved in the process have 
about evaluation?" What are the perceptions of the value of documenting the 
impact of the program on minorities with disabilities? 

When we look at knowledge we basically are looking at, does the staff, or the 
consumers who are actively involved in the process, have the knowledge to 
document an evaluation? Do they understand the purpose of the evaluation, why is 
it important, do they have the knowledge on evaluation in terms of developing a 
logic model? Sorry; in terms of evaluation language do they understand the 
difference between outcomes and outputs; do they understand the uses of 
evaluation?

Then when we move into skillsÐand this is all happening at the same time as we 
do brainstorming sessions about knowledge about evaluationÐwhy it is important 
for them to be able to document the impact of the programs on minorities with 
disabilities. They might be gaining skills and when we walk into some of these 
organizations you will find that different stakeholders are at different stages. Some 
might already have experience with evaluation; others this might be the first time, 
but for most of the staff this is identified as a need. 

Why? Because the funders are asking them, "Show me a logic model show; me 
an evaluation plan. Let me see the impact that you are having on minorities with 
disabilities." When we talk about skills, we basically train staff on how to identify 
and work with goals and how to identify specific goalsÐand we use the SMART 
formula for goalsÐHow to create a logic model for a program; how to implement 
evaluation, how to develop a survey; or how to prepare for a focus group with 
participants. 

ApplicationÐwe basically look at, does the staff know and have the skills that they 
have learned; can they put them in place? Can they apply those skills? Can they 
illicit consumer input into the programs? Can they identify the goals? Can they 
create the logic model and we actually see if they've done that and we look at it and 
provide them with feedback. 

The agency policy is really important when we are creating capacity. Is there a 
cultural for documenting impact? Is there a culture for specifying goals that are 
related to outreaching to minorities with disabilities and serving minorities with 
disabilities?

Next slide, please (6). Currently we are working with 9 organizations and 13 
grantees or affiliates, nationwide. A total of 22 organizations and 97 staff have 
been involved in different phases of our model. More than 13 evaluation training 
workshops have been conducted. How do we create that capacity? We provide 
ongoing consultation, on site training, technical assistance; a lot of the on site 
training is based on brainstorming. More than half of the organizations that we're 
working with, 3 VR state agencies, and a number of the agencies that we're 
working with, are specifically looking at goals that deal with outreaching and 
serving minorities with disabilities; in part because they are faced with a dilemma 
that minorities with disabilities are not achieving the same goals that other 
populations are achieving. In particular, 3 of our state agencies for vocational 
rehabilitation that are working with us using this model are basically, for the most 
part, trying to reach out and increase their successful closure, in most cases being 
successful job placement with African Americans and Latino populations. 

Next slide, please (7). Now, throughout this process of capacity building we are 
also looking at outputs and outcomes for our own efforts. Participants have 
reported that training activities, consultation, and brainstorming have been very 
useful and that they have been very, very satisfied with the trainings and the 
consultation and technical assistance that we provide. These are the means 
provided for how they rate key concepts provided, information outcomes 
framework, exercises, and materials and handouts. This is from a Likert-type 
scale from 1 to 5 where 5 is the highest positive point. 
 
Now we are as a Center, at this point, trying to figure out how do we measure Ðthis 
is satisfactionÐif capacity actually is happening. So we're now in the process of 
designing some surveys and interviews and checklists so we can actually check 
and see if they have a logic model in place, and if the logic model has all the 
components. 

So right now at the Center we're looking at how do we put in place the slide 
number 5 that I showed with the figure of the domains of building capacity: skills, 
knowledge and support. And we are in the process of collecting information on 
whether or not that capacity is there.
 
Now, the other fascinating thing we're doing in terms of moving forward is that 
we're asking the agencies and VR offices working with us using this model to track 
down their actions towards achieving their goals; to track down what specifically 
they do differently from what they've done before to increase outreach, services to 
minorities with disabilities, and increase their positive closure with minorities with 
disabilities. 

And this has been fascinating. I had a training last week with one of the midwest 
offices for vocational rehab. that was dealing with how do we outreach to 
minorities with disabilities. We specifically were specifically looking for activities 
and analysis and brainstorming on what can the VR office do with their staff to be 
able to outreach to minorities. And some of the staff members that were at the 
brainstorming talked about "Well, we need to go out and visit their local places of 
faith, where they practice their faith, their churches, their synagoguesÉWe need to 
go and visit these places and connect with grass root leaders and teach them 
about what VR does." 

Having these brainstorming sessions with the staff, and in most of the cases in 
the midwestÐexcept for the state of IllinoisÐmost of the staff happened to be 
Caucasian. But they are questioning themselves, "How do we increase positive 
closure and achievement of goals for minorities with disabilities?" But they are 
realizing that to able to increase that positive closure, and being job placement, 
they really need to go back to increasing and improving outreach to minorities with 
disabilities. Getting them to the door. And once you get them to the door, how do 
you modify practices and be culturally competent so they can stay within the 
service; that they can continue and be successfully placed at jobs or whatever their 
goal might be.

So this is where we are right now. We're just continuing to work with these VR 
offices, Independent Living Centers, and vocational rehab. We've been working 
with some of these programs for about a year, with others for about 2 years. 
Interestingly enough all of them are dealing with diversity-related goals. How do 
we increase positive outcomes for minorities, and I think this is really important 
that we're discussing these issues because agencies are struggling with these 
issues and I think right now I would like to invite Fabricio to come in and talk about 
how we're doing that part of the cultural competence. 

The other part, before Fabricio comes in, is many of these agencies in VR state 
offices are working with us on those two projects. They do the brainstorming of the 
goals, the identified diversity goals, and how they're going to document them; how 
they're going to increase the impact they are having on minorities, how to outreach 
them first and how to serve them and how to increase their impact. But now they 
want the staff to be trained on cultural competence so that they can improve 
outreach efforts, they can improve service efforts, and they can improve 
achievement of outcomes. So, often we have agencies working on the two projects 
together, because they are really, really linked. So I want to I invite Fabricio to come 
in and then we will entertain questions at the end. 

>> Fabricio Balcazar: Before I start describing the section on cultural competence I 
would like to mention a couple more aspects about this process of capacity 
building. We do have the capacity for any of you who are interested, in providing 
this service as a part of our mission and our funding purpose, through NIDRR, to 
work with you. We're always looking forward to having that opportunity and we have 
partners who have been trained and they are our collaborators. In the southeast 
and the south region is Paul Leung in Texas; we have Maria Restrepo-Toro at 
Boston University; we have Katie McDonald in the west site at Portland University 
and we have Christopher Keys, another collaborator here in the midwest. So we 
do have the capacity to work with agencies from across the country and if anybody 
is interested please feel free to contact me, send me an e-mail at my e-mail 
address: F A B R I C I O @ UIC dot EDU. We will be happy to put you in contact with 
the appropriate person to start helping you in this process of capacity building and 
program evaluation. 

(Slide 8). Now to start this conversation about cultural competence I would like to 
pick up a statement that Yolanda made about getting people through the door. If 
you want to get different kinds of individuals through your door then you must ask 
yourself a question that is very critical. Am I ready to serve those people? Do I have 
the capacity within my agency to provide the services to those people? And that 
might require some critical examination of the resources, the skills and abilities of 
the staff, the research team or the service providers in the settings. The concept of 
cultural competence in our nation is very important because we are a nation that is 
very diverse and it gets even more diverse every day. And we are constantly 
challenged, all of us, by the increased exposure to different people with different 
cultural backgrounds and experiences. The challenge to be sensitive, responsive, 
accepting and understanding and this process is what we hope that we will have a 
conversation about right now. 

Next (9). We'll start by asking what is cultural competence? It is a process 
that allows individuals to accept, respect, and work with others who are 
different from them. But we also have to understand that culture is an 
integral component of our own identity and culture reflects multiple 
dimensions of our being. Our preferences for food, for dressing, our accent, 
the way we talk, the way we see many practices about child rising or taking 
care of the elderly or how do we address our parents or how do we relate to 
authority. They are all reflections of culture. So we have to understand that 
culture permeates everything we do and everything that we are. 

Cultural competence is a result of awareness of the fact that we might have 
biases and the fact that we also need to have knowledge and awareness 
about the factors that influence the cultural differences and similarities 
among each other. We're going to explain these points in a moment when 
we show the conceptual model that we have been using to do this kind of 
training. This is a process that's required, the development of skills, 
changing attitudes and changing behaviors to allow individuals to 
understand and interact effectively with people that are different from them in 
any dimension. 

Next (10). Our cultural competence model is based on a model that was 
developed in the area of public health by Papadopoulos and Lee in 2002. 
This model presents a separate analysis of the components and the factors 
that influence cultural competence. 

These components reflect the circularity of the process of becoming cultural 
competent. Why circularity? Because we are in a never-ending cycle of 
improving our competence, improving our own knowledge and being 
exposed to new challenges and new experiences that require new learning. 
The factors reflect the differences and similarities within ethnic and cultural 
groups and we will look at the factors in a moment. 

Next (11). You're looking now at the model. This model suggests ongoing 
movement as I said before because of the need to be constantly updating 
our competence. The initial steps of this process are at the left side of the 
oval and it starts with critical awareness. 

Critical awareness reflects to our own understanding of our own personal 
experiences with diversity, our own biases and perceptions towards other 
people in any kind of dimension and I'm afraid we have to understand that 
we are not only talking about race although race is a major factor here, there 
are many things that also lead us to act in different ways towards each 
other. And we're going to be looking at those factors in a moment. But all 
those factors need to be considered critically. When we conduct this initial 
phase of self reflection, do we have biases against people of different 
gender or people who have different sexual preferences or people with 
disabilities or people who are older or people who are young and so forth, 
people who are poor, people who are rich? I want to emphasize that this 
process of reflection is very important. It's like looking at the mirror and 
saying, "Okay, who am I? Why do I believe these kinds of things about other 
people?" 

Very often this has to do with how we are raised in our families. How much 
exposure do we have growing up to diversity? And how much exposure do 
we allow through our daily life to diversity? How open are we to exposing 
ourselves to others that are different from us? And understanding our critical 
awareness means that we're going to come up to accept that we have or 
might have some biases. We need to learn what our biases are in order to 
deal with them. If we don't make those explicit we might just act on our 
biases even without being aware or conscious of the fact that we might be 
acting based on those biases. Because we have not stopped to think about 
our biases. For the process of critical awareness it forces us to look inside 
and look at our lives and see how those experiences are affecting the way 
we see and interact with others. 

The next phase is to develop some knowledge and understanding of the 
factors that impact cultural diversity. And I'm going to talk about those factors 
in the next slide but we're not going to move there yet. But just at this point 
it's sufficient to say that it's very important to have an understanding that 
there are multiple factors that can lead us to act differentially with one 
another. And we argue that race is only the first window. The initial 
impression we have from each other, but there are many other factors we 
will discuss in a moment that are very, very important to consider. Once you 
also seek to develop more knowledge and awareness about the factors of 
cultural diversity it's also important to develop the skills. 

Over to the right. The skills to interact, to listen, to accept, to greet, to 
understand our interaction with people from different cultures. Those skills 
are important and often they need to be practiced. That's why we argue this 
is not an intellectual endeavor. 

You actually have to take this process to practice. It has to become part of 
your daily experience, the way you interact with people on the bus or on the 
train or in your office or at church or in a synagogue or in the temples. It is a 
process of actually putting into practice your changes that you are making, 
your awareness, your understanding of other people. And the combination 
of these factors we argue will lead you in the quest of achieving cultural 
competence. And we call it a quest because we don't claim that it's a 
process that ends and we argue that it doesn't end because once we think 
that we have accomplished competence in dealing with one group of 
people then another group of people appears in our life that challenge us 
again. 

So we are constantly challenging ourselves to achieve greater 
understanding of cultural diversity and achieving cultural competence. 
Actually there are some researchers that argue to use the term cultural 
competence is a little complicated and probably challenging because it 
implies you can actually achieve this stage and then be satisfied and 
comfortable with that. "Oh, I went to this training so I am competent," and 
that might not be true. So, you know, this could be something for a 
discussion in the conversation later on. I hope to reflect a little bit about this 
concept of competency and whether or not it is appropriate to refer to it in 
those terms. 

Next slide (12). These are the factors that impact cultural diversity. As you 
see, race is outside but when we make the presentation in our trainings the 
race box that is now located on the left side corner goes around in circles. 
We argue that race is what we see, the physical features that generate an 
impression, the first impression that we make about other people. We 
argue that it is very important, yes, because we make assumptions and we 
often change our behavior or our demeanor based on that glance, first 
glance that we make at each other. However, we argue there are these 
other 10 factors and components that really determine the similarities and 
differences among people. 

We like to start by the circle that is yellow (socio-economic status) because 
we argue, and many other researchers argue too, that class differences are 
really critical in determining similarities and differences of many, many 
groups of people. 

Education of course is very important and the education of the population 
reflects a lot of their worldview. Also influence, the beliefs and values that 
people have about life. 

Religion is another way in which we also differ from each other. We just had 
a conversation in a seminar that we're teaching on this topic yesterday 
about the place, the role that religion is playing right now in the world and 
how unfortunate it is that it continues to be used to divide, missing the 
whole point of seeking a spiritual life and instead engaging in hatred 
because of the separation of these different points of view. So religion is 
important too.

The degree of acculturation, moving on slowly to the left side. The degree of 
acculturation, the people that come from over seas into a new culture is very 
important and there are gradients of degrees and impacts also regarding 
the ability to handle the language and also the degree of social identities 
that people acquire as they become multicultural. It's often a factor that 
determination eligibility or lack of eligibility to many services within the 
federal government and state governments. In the VR system for instance 
it's always an issue when we are dealing with some individuals with 
disabilities who are not eligible for services because of that factor. 

The degree of urbanicity. Often we see people in rural areas that have very 
similar challenges that are very different from the ones that people in urban 
inner city environments face. 

Gender and sexual orientation are also important factors in the way we 
respond differently between men and women and the way we tend to 
respond to individual sexual preferences. 

Disability, of course, and ability and age as a factor are critical. And here you 
understand how complex this can become when you also take into 
consideration hidden disabilities versus obviously apparent physical 
disabilities and how people tend to generate additional, discriminate 
individuals that on the basis of what they see also in terms of limitations of 
individuals that they are serving or working with them. 

The degree of family and community support that people have. Some 
individuals might have very little family and community support and that is 
likely to affect the success of many interventions. 

We like to call attention to oppression. The oppression experience in our 
opinion is very important and this is a factor that is not often included in this 
type of analysis. We argue that the individuals who are migrated to this 
country and individuals who also belong to lower economic status share a 
lot of experiences of oppression that limit very often their sense of 
entitlement and their capacity to engage in advocacy and self determination 
activities. Also it is also very common that those individuals might lack 
knowledge of rights and services. 

So it's important to consider all these factors when looking at the individuals 
that we're trying to work with and consider that it's not only the race but all 
these other factors that really determine our own similarities and 
differences. 

Next (13). As you can infer, our model is a process that's ongoing and the 
components are inter-related with each other. The process of cultural 
competence is contextual, meaning you may be more challenged in some 
contexts than in others. For instance you may be challenged in your work 
setting but not in your neighborhood or the community where you live. The 
process is developmental, meaning that it's a process that has the capacity 
to transform the individuals that engage in this process. The process 
produces multiple outcomes because it changes how we see our self and it 
can change hopefully how we relate to each other. And it's very difficult to 
predict what those outcomes are going to be. The process is also 
experiential. This has to be put to the test and tried out with others. 

And one thing that we do as a central component of our training in cultural 
competence when we work with agencies and staff with different 
organizations, is we ask them to set goals. Specifically to attain 
organizational change related to cultural competence. Very often the 
agencies are thinking in terms of improving outreach, recruiting new staff 
that will allow them multicultural experience or bilingual competencies, and 
so forth. The process that we do with agencies implies also a follow up and 
we not only work for our one day working with agencies but we commit to 
follow up the agencies, and provide technical assistance and support for up 
to 6 months following our training. 

Next (14). We have conducted to date 20 trainings involving 62 
organizations. The majority have been organizations serving people with 
developmental disabilities and mental health and VR offices. We have had 
over 500 staff members participating in our training, and as I mentioned, we 
provide follow along consultation and technical assistance for up to 6 
months after training. We have worked with 44 organizations that accepted 
our challenge to set goals and participate in follow up interviews, and we 
have successfully completed between 1 and 3 follow up interviews with 35 
of these organizations. 

Next (15). In terms of outputs regarding the satisfaction with the training, the 
ratings have been high, 4.83, and we wanted to share briefly some of the 
outcomes that we have also encountered in the process. 

In terms of changes in practice, participants have reported 135 goals to 
change practices that were set and maintained. Participants made 
progress toward goal accomplishment in about 55% of the goals were 
actually accomplished or they make progress and they actually 
accomplished almost 22% of the goals that they set. But the 
accomplishment is an ongoing process so this is a picture, a still picture 
we're taking in a given time. 

Examples of goal accomplishment. One agency developed a collaboration 
with their state welfare to work program to hire a bilingual staff as para-
professionals; people who could speak Spanish and Somalia. Another 
agency was successful in obtaining funding to produce the first ever 
developmental disability diversity newsletter in their city. Another agency 
hired 3 minority individuals in upper management positions. 

We have another example of change in policy. One agency developed a 
policy to require health care professionals who want to be included in the 
preferred vendor list to attend at least one diversity or cultural competence 
training a year in order to provide, to improve the degree of competent 
services that these people are providing to their clients. 

So to summarize this part we are very excited about the opportunity that we 
have had to work with agencies, and I said before this is a service that is a 
part of our mission as funded by NIDRR, so anybody who is interested in 
receiving cultural competence training in their agency feel free to contact me 
through my e-mail and I will put you in touch with our training director to 
schedule these events. 

We are very excited because now we're working with the department of VR 
services in the state of Illinois to do a statewide cultural competence 
training involving more than 100 employees in the state. What we're doing 
here is a train-the-trainer model using the training team for the state which 
we already trained and making some modifications to the curriculum so the 
curriculum is more focused on VR services and needs, and we're going to 
start the actual training process next month. So we've been excited about 
that. Just to recap, my contact information is my first name, 
Fabricio@UIC.EDU. Send me an e-mail if you're interested in participating 
in the cultural competence training. 

(Slide 16). The last section of the presentation we want to provide some 
brief recommendations for conducting culturally competent research. These 
are generated in part from our own personal experience and current 
literature. We'll start by the need to recognize that as cultural beings we 
might hold attitudes and beliefs that can influence our perceptions and 
interactions with individuals who are different from us. And this is in part due 
to upbringing, negative past experiences, lack of experiences with that 
particular group, negative media influences, lack of knowledge, perceptions 
of stereotypes and or class differences. 

Next (17). Comparative studies should be carefully conducted. We 
encourage people to avoid using white middle class standard for 
comparison that will make other minority groups look inferior. 

Number 3. Encourage people to utilize multiple strategies for community 
entry. We in our work use a lot of personal contacts, gatekeepers, 
paraprofessionals and we also volunteer to help ourselves. So we have a 
direct presence in the communities that we work with through our own 
volunteer contacts and efforts. A lot of the effort that we do to really gain entry 
into the community is conducted through these personal contacts and 
paraprofessionals. We strongly recommend the use of paraprofessionals. 
Who are these people? Members from the community that you are targeting 
that you hire, train, supervise, monitor and they become your project in their 
community and they become your contact in the community. We have been 
successful with this particular approach. 

Next (18). Outreach should include multiple strategies including direct 
community contact through paraprofessionals but also radio and local 
newspaper announcements in the target population language whenever 
available and fliers and posters in local stores and agencies frequented by 
the target group. These are pretty much the standard procedures. 
Unfortunately many communities do not have radio or local newspaper 
announcements in the target population language. In Chicago we do have 
that opportunity and this mean it's very accessible. 

Next (19). When not finding protocols or assessment instruments needed 
to do evaluations with the target community, keep in mind the cultural 
appropriateness of these instruments in the development of materials. 
Remember it's not enough just to translate materials and protocols without 
considering whether or not the instruments have norms that reflect the 
particular population that you are going to assess using those instruments. 

Next (20). When utilizing strategies to ensure community input and active 
participation in research ask the gate keepers and paraprofessionals who 
represent the community best and how do you assure community wide 
representation? Communities can be very complex. They have histories. 
They have people with good and bad representations. So make sure that 
you make the right choices because you are coming in as an outsider often 
and you don't know what's going on there. 

Next (21). Intervention programs and/or services developed for members of 
the majority culture should be carefully scrutinized before being used with 
minority groups. This is often a very important issue of concern because as 
researchers we barely have enough resources and money from the 
granting agencies to develop our interventions with particular populations 
and then we very quickly think about the dissemination and we often don't 
find enough resources and/or time to try the interventions with different 
populations. 

I have had that experience working in the area of transition for youth about 
disabilities. The guidelines for the state of the art has been very often 
developed for a white middle class youth with disabilities and we often 
realize that doesn't work when we try to implement the same guidelines in 
the inner city. Because those kids don't have the same resources and 
opportunities that are part of that state of the art guideline. So it's very--this is 
a challenging proposition because we often don't have enough time or 
resources to examine our interventions with different populations. But I 
would like to call people's attention to this fact. 

8. Before reaching out to new populations, make an effort to improve the 
cultural competence of your research team with regards to the particular 
target group. Meet with people from the group and try to learn as much as 
you can from them. And of course if you can hire one community member 
from that target group and invite the person to sit at your table and share 
with you and attend your research meetings then you're going to increase 
your awareness about the community too. 

9. Make an effort to recruit multicultural staff including students and/or 
paraprofessionals since they improve your effectiveness in interacting with 
the community. I know this could be an issue for some people that are 
located in areas that--where this is not often, you know, possible. But as 
much as you can make an effort to recruit people who are diverse because 
they improve the quality and the richness of your own team. 

(Slide 22). All right. Now we go to the conclusions and in a few minutes we 
will open the floor for your questions. So in terms of conclusions we can say 
participatory evaluation is an effective strategy to improve the quality of 
services and outcomes for individuals with disabilities. The process of 
participatory evaluation can change organizational culture in a very positive 
way. 

Next (23). Cultural competence is an ongoing challenge for researchers 
given the great diversity of our nation's population. Researchers can set up 
mechanisms to promote cultural competence among research teams 
through recruitment, training, exposure, and engagements with diverse 
groups. Effective outreach efforts require multiple channels of 
communication and the direct involvement of community members in the 
research team. 

Next (24). Our Center is making a speedy progress in meeting all of its 
original goals. We would like to announce that in July 25 and 27 of next year 
we will have our national conference on the state of the art and we plan to 
edit a textbook to influence the training of future professionals and 
researchers in this topic of capacity building and cultural competence. 

Next (25). We would like to share with you some references that we have 
found useful in terms of out reach for instance, the paper that I published in 
2001 in The Research Exchange and especially the National Council on 
Disability 2003 summary of outreach and people with disabilities from 
diverse cultures. This is one of the best summaries of the literature that we 
have come across thus far. There are also guidelines from the American 
Psychological Association on multicultural education and that's very helpful 
to people interacting in different ways with people of color. 

Okay. So that concludes our part of the presentation and I'll go back to Frank 
and Joann to talk about the questions. 

>> JS: Thank you very much, Fabricio and Yolanda. Both were very interesting 
presentations. We do have a couple of questions that we would like to pass on to 
you. 
 
One is, "Can you suggest some resources for my research colleagues who are 
primarily white and middle class to help them recognize their own cultural identity 
and its effect on their interaction with others?" I think you mentioned this; how 
important it was that people do that reflection. Are there some resources you can 
help point us to? 

>> FB: I think it's helpful for people to seek and participate in some type of 
workshop or training event that will allow them to stop and engage in conversation 
with others about topics of cultural diversity and cultural competence. I know that 
several universities are starting to consider this as part of their diversity training.  
But I encourage people to be active in seeking or identifying places or locations 
where they can, they can attend these kinds of trainings that are helpful. I think we 
all need to at some point slow down, stop, and engage in conversation about 
these topics with others and have a reflection about these topics. 

>> YS: I want to add a couple of resources. There are two books that we're 
currently using in the class. The class is called "Diversity, Disability and Cultural 
Competence" and these two are, one is called Multicultural Aspects of Disabilities: 
A Guide to Understanding and Assisting Minorities in the Rehabilitation Process 
by Bryan, 1999. This is from Charles Thomas publisher and the students have 
found this to be very helpful. The other one we use that is very helpful, is 
Transcultural Health Care: A Culturally Competent Approach, 2nd Edition. It is by 
Purnell and Paulanka, 2003. The first one by Bryan I believe has exercises. 

The other thing that we have encouraged our graduate students to do in the 
classroom is go out and have multicultural experiences. To walk around a 
neighborhood in Chicago that they have never been by that is multiethnic. Whether 
it's Chinatown, whether it's the Polish part of town, African American, to just get a 
sense of being around people who are different. To volunteer at community 
agencies, to go to interact with people they know who are different from them. And 
that experiential part of it has been very helpful too. 

>> FB: I remember when we also engaged in these kinds of activities. We 
occasionally have also organized like reading clubs or box book clubs where we 
come together with a particular book of interest to several people in this topic and 
we have conversations about it and try to open up the ways in which this particular 
reading impacted our views of ourselves and a particular group. There are a 
number of books that are very fascinating to expose people. You know, my main 
plea regarding this question is you have to facilitate opportunities for people to 
have dialogue, to converse with each other, to engage in conversation and to talk 
sincerely and openly about their views. That is really a good point to start. 
Especially if there are not--if there is not ready access to specific trainings or 
workshops. 
 
>> JS: Okay, thank you very much for that input. We do have another question that 
came in. This also I think you touched on. "Can cultural competence really be 
measured?" I know you talked about there being some discussion as to how the 
use of the term competence implies that you can become an expert or become 
competent. What is your feeling about measurement of competence? 

>> FB: Yolanda, why don't you respond to this? 

>> YS: Yes, we've done an exhaustive literature review of the different 
assessments of cultural competence and there are some instruments out there, 
there are some surveys out there that mostly get at the attitudes and knowledge. 
It's really hard to get at the skill and the application part of the model that Fabricio 
described because you're basically trying to figure out how do people behave in 
the real context of services, can they really display and apply the skills and put 
them in the context of outreach, services, and research. So service and skills that 
we have reviewed, for the most part have covered those two, knowledge and skills. 
But only a few, only a few happen to have been actually pilot tested and validated 
as instruments that really measure what they are intended to measure. 

We are right now in the process, with a graduate student in the Department of 
Occupational Therapy and some of the staff at the Center for Capacity Building, 
we're right now starting a study where we're going to tryÉwe already conducted a 
literature review, develop a survey and we're going to try to come up with an 
instrument that we're going to validate and pilot test. 

So, yes, the answer is cultural competence can be measured. What is it that you're 
measuring? You're measuring some specific domains that mostly relate to 
knowledge and attitudes. Can the skills and applications be measured? We may 
use some of our knowledge from behavioral science to develop some kinds of 
checklists and videos where people can go in and look if they are really applying 
the skills. But I think that's the toughest part: How do we measure the 
applications? Do staff that goes through training; did they really put them in 
practice?

Gaining cultural competence is an ongoing process. It's a process with no end but 
a becoming, ongoing process. Really it's the person's perspective and success in 
connecting, relating to the experience of those who happen to be minorities with 
disabilities that she can really or he can really say, "I feel more competent and I'm 
having a better way of communicating, of understanding" or "I'm starting to have 
more success with a person with a disability who is from a minority background, 
than I used to." 

So I think the personal indication of where I am as a researcher, practitioner, or 
service provider and also the use of specific surveys. The surveys that we have 
reviewed in our extensive literature review of models and skills and assessment, 
as I said, it's pretty much staying at the attitude and knowledge level. Yes we can 
measure it. We need to move that part of the field in developing and pilot testing 
and validating the measures. And we need to learn from our developing and pilot 
testing of measures, exactly what it is that we're measuring and what are some of 
the challenges that people have in measuring cultural competence. 

It is a challenging area. It's not that easy to measure and in part because we don't 
have those validated instruments. There are a couple, but there are a lot of 
instruments and a lot of surveys that people have put together to measure different 
domains that speak to cultural competence. 

>> FB: I would like to add, Yolanda, that the instrument that we are developing is 
trying to address the four areas in our model: the critical awareness, the 
knowledge factor, the skills, and the application. But it is particularly focused on 
either the therapeutic interaction or service delivery kind of context, no, Yolanda? 

>> YS: Yes. It's not addressing "Are we culturally competent as researchers?" And, 
I don't remember from the literature review that we conducted and the analysis of 
assessment if there's actually one instrument that is validated and pilot tested with 
researchers. There's a lot of research that's being done in this area in two fields: 
Nursing; the Papadopoulos and Lee model comes from nursing and they have 
developed a number of models; and also from Multicultural Counseling 
Psychology. 

>> FB: Yes 

>> YS: So I would encourage you to look at those two areas. 

>> JS: Thank you.

>> FM: Okay, thank you. This is Frank. We have another question in and it is a 
methodology question pertaining to your study. The individual would like to know: 
"Does your study involve any analysis of RSA-911 data or interviews with 
consumers?"

>> FB: I don't know if they are talking about our studies with capacity building--or 
our studies with cultural competence. Would you like to respond regarding 
capacity building, Yolanda? 

>> YS:  Regarding capacity building, the kinds of information that we get in capacity 
for evaluation has focused and centered on staff. Staff of VR, staff of ILC's, and the 
staff of CBO's, but not on consumers. Consumers have been--we are encouraging 
staff and working with the staff to incorporate the voice of consumers as they 
brainstorm about the programs. The voice of consumers, to identify their needs, 
their goals and what the program is going to do, the impact of the program; and 
the data that we're currently collecting is basically from the perspective of staff. 
Capacity for evaluation from the perspective of staff. 

>> FM: Okay, thank you. 

>> FB: With regards to the cultural competence, all of the people who have 
attended our training in cultural competence are service providers and staff 
members. So we don't have up to date that aspect. What we do is challenge them 
to think about the persons that they are working with and we allow often the staff 
members to engage in very interesting conversations about some of the 
organizational issues that they are facing. 

I can mention for instance one organization in which there was tension between--
because the upper management, a skeleton of the organization, were white--the 
managers. The majority of the direct line, front line service providers were black. 
The majority of the consumers were aging white individuals with developmental 
disabilities. And a lot of the black individuals within the organization felt a lot of 
pressure from multiple directions to deal with issues of racial tensions and so 
forth. So, people do engage in conversations with regards to how they see their 
clients and the people that they are serving. 

Another typical reaction is, "But we don't serve those people." Well, why is it that 
you don't serve those people? Is it because those people are not coming through 
your door or is it really because those people are not there? And in your community 
and some of the things we are finding in the conversations with the staff members 
is that the strategies they have implemented historically for outreach don't meet the 
needs of the changing population in the community. And this is a complaint we 
often hear. 

The communities are changing. But the race the ways of the agencies are not and 
because of that their client population changes and diminish with regard to the 
historically white consumer, but they have been not been to recruit the new 
consumers from the community. 
 
>> FM: Thank you. We have one final question. It appears more as a comment. But 
the person says, "Many of the problems with cultural competence or multicultural 
competence training is that they are simply too short. It is a one shot type of 
training. Many people attend them and think, "Okay, I've got it." With something so 
complex as culture how do we emphasize the need that this is an ongoing 
process? What are your thoughts on this matter regarding short term versus long 
term training?"

>> FB: Yes, I fully agree with this statement. That is one of the reasons why we 
decided to commit our resources through the Center to work with the agencies for 
at least 6 months following the training because we know that often these 
trainings are an excuse not to go to work for one day. Forget about the routine, 
have a good time, engage in these conversations, kind of interesting--and then 
forget about it, you know. But that is not the case. That shouldn't be the case. I 
agree. 

With regards to cultural competence we want our trainings to become the first step 
in a process that people will start to undertake with regards to changing their own 
views about others. So we like to challenge in our presentation, to challenge 
people to think about the ways that they often interact and participate in workshops 
and to think that we want this experience to be different for them. 

Because, while we are discussing and they are conversing with each other it's not 
something trivial, this is something that in our opinion is very, very important. Not 
only for them but also for the clients and people that they are working with. So we 
really encourage people to understand that this shouldn't be a one shot kind of 
deal. That this is an ongoing process that is life-changing and that it is their life 
and this is worth experiencing, because we argue very strongly that this kind of 
knowledge and understanding will make them better persons. 

>> YS: I would like to add, that one of the ways that we have provided that 
continuity, is that both the capacity building for documentation evaluation and the 
cultural competence training participants are asked to identify a goal that they're 
going to work on. 

As Fabricio said, for us, the training is just the opening. It's just the first attempt to 
stir the pot. But I think it's the continuity in leaving after training or after talking to us 
about evaluation with what is one of your goals about increasing outreach, 
services, or research to minorities with disabilities. And it is that follow-up 
continuity that really provides that ongoing process. 

>> FM: Thank you for that response. I would just like to comment I think what you 
described today is really a proactive approach to addressing this issue and more 
so, it really seems to be grounded in reality. The reality that service providers are 
going through today. 

>> YS: Right. And related to that we were just doing a training or a follow up in one 
of our state VR agencies. Often the reaction from the staff is, "Why do I have to 
change the way I provide services or outreach? I've been doing this for about 30 or 
40 years as a VR counselor and you're asking me now to think differently because 
7% or 10% of our population is minority." 

I think it was a really good question but staff, you know, the white/Caucasian staff 
are raising the questions to themselves: "Why are you asking us to do this training 
or worry about diversity goals if what we've been doing has been working?" I think 
the key question is, it's not working for minorities and the data and the census 
keep telling us that specifically, more specifically African Americans and Latinos 
with disabilities and native Americans with disabilities are not achieving 
independent living goals, job placement goals with the same rate that other 
groups are. They're falling behind and that's why we really need to attend to these 
issues. 

>> FM: Well, I think we're just about out of time so I'm going to hand it over to Joann 
now. 

>> JS: I actually do have another question that is a little bit different from what 
you've been talking about and yet I think it's important for our NIDRR researchers. A 
lot of times in doing research they have very small numbers of subjects that may 
be involved in the research study and the researchers will tell us that it's difficult 
when they already have small numbers to then be able to diversify and make sure 
they have good representation from a variety of minority populations. Do you have 
any answers for that, and again, in an era where it may be difficult to recruit people 
to participate in studies? 

>> FB: I would say that one of the strategies that we recommend to our colleagues 
and we have implemented ourselves is to create partnerships with multiple 
institutions. So if you are a rural or in a small University town you might want to 
build some kind of partnership with somebody that's in an inner city that has 
access to a wider spectrum of clients and diversity. 

Those partnerships are being encouraged by NIDRR over the last few years 
because of the way some of these RFP's are being written and encouraging 
multisites; when you have diversity of sites you also immediately gain diversity 
access to different populations.

I think that if we worry about the effectiveness of the interventions or the 
instruments or the techniques that we develop and we have not been able to pilot 
them with possible populations that will be utilizing them later on in our 
dissemination phase, it's problematic when we don't, include or consider that 
diversity. So my suggestion is through partnerships and it's a little bit of a 
challenge I understand because that implies we have to consider sharing some of 
our scarce resources. But, you know, I have had very positive experiences with 
building partnerships with people from around the country in this project and it has 
been very beneficial and positive for us. 

>> YS: Another set of strategies that I can suggest is that often people with 
disabilities and more so minorities, may not have the experience of participating in 
projects. And I think we need to be more aware of how do we highlight the benefits 
and think critically if we need to increase the number of people with disabilities, 
minorities with disabilities in my research study, what are the benefits for them? 
Can I articulate the benefits? Why would they want to come or participate in my 
focus group or in my study? What am I offering to them? We really need to be more 
careful about that reciprocal; they're giving us their time, their effort, completing 
surveys, participating in a focus group--what do they get out of that? We need to be 
able to articulate what is the benefit. 

Attending to issues of having incentives; we have used incentives and that seems 
to attract in any population more willingness to participate. In minorities with 
disabilities we do a lot of one on one contact. If we have one participant we have 
incentives to bring 2 or 3, friends or someone he or she knows and using a lot of 
the key leaders and one on one contact has also helped.

>> JS: Thank you very much. We really appreciate your presentation today. 
 I think you've given us a lot to think about and I'm sure everybody will find it 
informative. We haven't received additional questions so we may go ahead and 
wrap up a few minutes early this time. If you do have questions you can go ahead 
and send them, Dr. Balcazar has given us his e-mail address a couple of times or 
send a question to: web cast at NCDDR dot ORG and we'll make sure the 
question gets to our two presenters for their responses. 
 
Dr. Balcazar and Dr. Suarez, I want to thank you very, very much, and also thanks to 
everyone for participating in the webcast this afternoon.

>>YS: Thank you for the opportunity.

>>JS: An audio file and transcript of the webcast will be available on the ILRU 
website archive page in a couple of days. You can find this at: www.ilru.org. 

On behalf of my co-host, Frank Martin, and the rest of the staff of the NCDDR, I 
want to thank the National Institute on Disability and Rehabilitation Research, 
NIDRR, that provided funding for the webcast and I also want to especially thank 
the staff at ILRU, because without their efforts, the webcast could not have taken 
place. We also appreciate the efforts of the staff at "CommuniquŽ" for the real-time 
captioning today. Thanks to all of you. 

We do hope you'll join us for our next webcast, which will be on December 6. The 
presentation will focus on "Knowledge Translation and the Canadian Institutes of 
Health Research (CIHR)", the agency credited with coining the term, "Knowledge 
Translation."

Thank you very much, and goodbye.