A Guide to Success: Serving People with Disabilities of Various Cultures Learning Objectives -Discuss Assumptions, Stereotypes and Generalizations -Define Culture and Cultural Competency -Learn about Disability and Various Types of Disabilities -Understanding Service Animals and Other Accommodations -Examining the Effects of Violence and Trauma on Disability -Response to Victims with Disabilities -Any other topics? M Generalizations vs. Stereotypes Generalizations are statements or beliefs about a cultural group based upon factual evidence. While generalizations apply to the majority of people within a cultural group they may not be true of every single person within that group. Generally speaking, the majority of Latin Americans are Catholic, but not every Latin American is Catholic. Stereotypes are oversimplifications of a group’s characteristics. Stereotypes can be based on some factual elements but are not generally applicable to an entire cultural group. It would be accurate to say that there are many African Americans who are rappers or who play professional basketball. Saying that all African Americans play basketball and listen to rap would be stereotyping. JC Where are you from? Have you been asked the question “Where are you from? I have…many times. Let us watch the following video: http://www.youtube.com/watch?v=crAv5ttax2I JC What is Culture? Culture is an integrated pattern of human behavior includes but is not limited to – thought, communication, languages, beliefs, values, practices, customs, courtesies, rituals, manners of interacting, roles, relationships, and expected behaviors of a racial, ethnic, religious, social or political group; the ability to transmit the above to succeeding generations; dynamic, ongoing and evolving. Developed by the National Center for Cultural Competence, 2001 JC Cultural Competency Cultural competency is defined as “a set of cultural behaviors and attitudes integrated into the practice methods of a system, agency, or its professionals, that enables them to work effectively in cross cultural situations.” JC How do I achieve Cultural Competency? Cultural competency is achieved by translating and integrating knowledge about individuals and groups of people into specific practices and policies applied in appropriate cultural settings. JC Iceberg Concept JC Cultural Sensitivity/Safety Cultural Sensitivity is being aware of cultural differences without assigning value (i.e. better or worse, right or wrong) to those differences.. Safety : Being in compliance with rules, regulations, policies and laws. This includes showing respect toward people regardless of race, national origin, religion, disability, sex/gender (including pregnancy), color, veteran status, age, sexual orientation, gender identity/expression, or genetic information. USU Policy 305.1 JC Ethnocentrism “What you see in yourself, you see in the world.”- Afghan Proverb It is the universal tendency of human beings to feel that their ways of thinking, acting, and believing are the only right, proper, and natural ways of interrupting life. This mindset is called Ethnocentrism (ethno=nation; centrism=centric). An ethnocentric person is akin to someone looking in a mirror in that they only see a reflection of themselves. A culturally sensitive person understands that everyone has a different cultural background and may not interpret the world in the same manner as they themselves would. (Lynch & Hanson 1992 Developing Cross Cultural Competence) JC Effective Communication Communication provides an opportunity for persons of different cultures to learn from each other. It is important to build skills that enhance communication. This means not only using the language and dialect of the people you are serving, it means using communication vehicles that are proven to have significant value and use by your target audience. JC Stages of Intercultural Sensitivity 1. 2. 3. 4. 5. Denial: does not recognize cultural differences Defense: Recognizes some differences, but sees them as negative Minimization: unaware of projecting of own cultural values; sees own values as superior Acceptance: shifts perspectives to understand that the same “ordinary” behavior can have different meaning in different cultures Adaptation: Can evaluate other’s behavior from their frame of reference and can adapt behavior to fit the norms of a different culture JC People with Disabilities M Largest and most diverse group People with disabilities constitute our largest and most diverse minority group (one in five Americans), encompassing all ages, genders, religions, ethnicities, and socioeconomic levels. It is also the only group that any person can join at any time, and will if they live long enough. Disability is a natural part of the human experience. People have the right to live independently, control their life, and fully participate in their community. Disability is often a result of social, architectural and environmental barriers. Barriers exist within society, not within the person. Children and adults with disabilities are unique individuals with unlimited potential, like everyone else (Snow, 2008). M General Communication Recommendations for People with Disabilities Rethink your attitude about people with disabilities. Don’t make assumptions. Treat them the same as everyone else. Don’t treat them like a child or say, “honey” or “sweetie.” Always ask before helping. Wait and listen. Ask how they prefer to communicate. Treat individuals with disabilities with respect, dignity and courtesy. M Hidden Disabilities may include: Traumatic Brain Injuries Mental Illness Hard of Hearing Learning Disabilities Mild Multiple Sclerosis Chemical Sensitivities Heart Disease Arthritis Chronic Fatigue Can you think of any others? M Misperceptions Be aware of misperceptions and common assumptions: People with cerebral palsy may appear to be under the influence of drugs or alcohol. People with traumatic brain injuries may act aggressive or irresponsible. Individuals with mental illness may have trouble listening and staying on task. People who are hard of hearing may not respond. N Individual Differences • In the next section, several disabilities will be discussed along with communication suggestions. • This information is very general and is simply intended to provide a broad overview. • Please keep in mind that each individual is unique. Symptoms of disability may also vary from day to day for an individual. N Communicating and Interacting with People with Developmental Disabilities Diverse group of severe chronic conditions that affect major life activities such as language, mobility, learning, self-care, selfdirection and independent living. Begins anytime during development from birth to 22 years of age and usually lasts throughout a person’s lifetime. Includes autism, cerebral palsy, Down syndrome, and intellectual disabilities. N Cognitive/Intellectual Disabilities Limited ability to think, remember, interpret social cues, and understand numbers and symbols. Possible communication difficulties: Limited vocabulary Short attention span Slower information processing Difficulty understanding questions Memory gaps N Communication with People who have Intellectual Disabilities Talk to the person to get a sense of their abilities. Help the person feel safe, be patient and establish trust. Use short words and sentences. Provide more time to respond with breaks. If person doesn’t respond, calmly rephrase. Ask them to repeat what you told them. Let them know it’s okay to say, “I don’t understand.” Break complex information into smaller parts and give directions one at a time. Describe things clearly. Offer help with instructions or completing forms. They may be easily distracted. Repeat if needed. (U.S. DOJ, 2002) N Muscular/Neurological A broad range of disabilities affect movement. Cerebral Palsy is caused by damage to the brain with limited control of motor functions. May have speech difficulties, unsteady gait, slow reactions. Does not affect intelligence but may co-exist with intellectual disability. Multiple Sclerosis is a chronic disease which attacks the central nervous system (brain, spinal cord and optic nerves). Severity and symptoms vary, but often tire easily, with tremors, pain, and coordination difficulties. Vision, speech, hearing and cognitive function may be affected. N Communicating with people who have difficulty speaking People with Cerebral Palsy, Downs Syndrome and some other disabilities may be difficult to understand. Provide extra time and let people talk at their own pace. Give them your complete attention. Ask them to repeat if you don’t understand. Never pretend to understand. Ask yes/no questions if necessary. Repeat or rephrase what the person is saying to clarify that you understand. Be patient, flexible and encouraging. N Communicating with people who use wheelchairs or scooters Offer to shake hands, even if the person appears to have little strength or movement. When talking to a person in a wheelchair or scooter at any length, sit or kneel so that they don’t have to strain their neck. Talk directly to the person. Don’t lean on, push, pat or touch a person’s scooter. If a person is unable to hold a pen, ask how you can help. For instance, “Would you like help filling out this form?” N Traumatic Brain Injury (TBI) • A brain injury may result in changes in behavior, thinking, personality, and appearance. – Lacking in impulse control – High degree of frustration and anger – Poor executive function (say what they think) – Inappropriate decisions – Difficulty solving problems – Lack of self-monitoring – Easily fatigued M TBI Communication Tips Simplify as much as possible. Get the person’s attention, redirect if needed. Ask short, simple questions in a calm way. Wait for a response. Rephrase if needed. Highlight important information. Watch for sudden outbursts or change in behavior. Expect the unexpected. M Autism Spectrum Disorder • Complex brain disorder that primarily affects communication, social skills and behaviors. • Affects every person differently and to varying degrees – on a spectrum. • May exhibit repetitive language (echo), hand flapping, twirling objects or rocking. • Many have little or no eye contact. • May have fixation on parts of objects. H Autism Spectrum Disorder • • • • • • • Try not to touch the person, if possible. Do not stop the person from rocking or flapping. Visual information may be better, if possible. Ensure questions are direct and clear. Give the person more time to respond. Turn down lights and sounds, if possible. Words are taken very literally. Don’t use metaphors or sarcasm, like you’re pulling my leg. H Communication with Persons who are Blind Visual impairments range from mild to severe. Identify yourself and anyone with you. Don’t just start talking. Let the person know when you leave. Speak in a normal tone of voice. Always ask the person what is the best way to provide assistance. Describe , (e.g. there is a table on your right). S Guiding a Person who is Blind • If you need to guide the person, offer your elbow, and let the person hold on to you and identify obstacles, such as steps, low hanging objects. • If you offer a seat, place the person’s hand on the back or arm of the chair or pat the chair. • Don’t grab, distract or pet a guide dog. • Don’t separate the dog from the person. • Provide information in electronic or other alternative format. S Service Animals • Any dog trained to perform specific tasks for persons with disabilities, such as guiding a person who is blind, alerting a person who is Deaf, helping a person with cognitive disabilities navigate, picking up objects or the phone, alerting for seizures, providing help with balance or interrupting impulsive behaviors. • You may ask two questions: – Is this a service animal? – What task has this animal been trained to perform? • You may NOT ask: – About the person’s disability – For a demonstration of tasks – Documentation of training, certification, license • It is the responsibility of the handler to control, care for, feed, and supervise the service animal. S Reasonable Accommodations • Federal law requires reasonable modifications to policies, practices and procedures for persons with disabilities, unless it fundamentally alters the service, program, or activity the agency provides. • Ensure that communication with people with disabilities/Deaf individuals is as effective. S Deaf and Hard of Hearing • Demographics • Utahans with Hearing Loss: 226,979* (and counting) • Seniors (55+) 99,952 • Culturally Deaf: 204 • Mild to Severe Hearing Loss: 224,664 • Profound Hearing Loss: 2,111 MM Who Are They? American Sign Language (ASL) users, sometimes known as culturally Deaf. Bilingual users of ASL and English. In this context, ASL may include a wide variety of manual communication forms. Oralists and hard of hearing individuals who use their voices and rely on speech reading or residual hearing. Deafened individuals who become deaf after hearing normally, usually after learning to speak. Elderly persons who lose their hearing, sometimes called Late-deafened adults. MM Who are They cont. Deaf people who know neither ASL nor written English. These people may speak but not write; they may be new Americans, or persons, who use home signs, gesture or mime. Deaf-blind individuals who use Braille and/or tactile signing to communicate. Persons with speech disabilities may include people with single or multiple disabilities. MM Deaf Culture English as a Second Language— For those who become profoundly deaf as infants, learning to use English is like trying to build a house without plans or carpentry experience. -- Lou Ann Walker, Author on Deafness MM Communication Strategies 1) 2) 3) 4) 5) Maintain Eye Contact Use paper and pen/pencil for clarification Admit when you don’t understand Use appropriate ways of getting attention Learn to use Instant Messaging, text, Fax Machine, and/or Relay Service 6) Use the term “Deaf” and/or “Hard of Hearing” 7) Don’t cover your face (visual input is necessary) MM Communication Strategies cont. 8) Don’t shout or whisper in their ear 9) Don’t assume all Deaf and Hard of Hearing people are good lip readers 10) Don’t assume someone with a hearing aid can understand speech 11) Don’t allow others to interrupt 12) Don’t correct a Deaf person’s English skill 13) Treat Deaf and Hard of Hearing people as individuals MM Technology for D/HH • Assistive Listening Devices (FM/Infrared/ loop systems) • Alert Devices (Flash, Vibrate, Pagers) • Communication Devices (Video Phones, Smartphone apps, TTY) • Computers/Laptops (Several available software) • Interpreters MM Person First Language People with disabilities are people first. They are not all alike. The only thing they have in common is prejudice and misunderstanding. They are all unique (Snow, 2008). Portrays people with disabilities as independent, productive, valued, and respected members of society. Person first language puts the person first, with a description of their disability, if necessary. Child with a disability, woman with M.S., person using a wheelchair. It describes what a person has, not who a person is. H Domestic Violence can cause temporary or permanent disability • Domestic Violence is the leading cause of injury to women between the ages of 15 to 44 in the United States. • Disabilities resulting from abuse can range from actual physical disabilities to more hidden ones, like head injuries, spinal cord injuries, and Post Traumatic Stress Disorder (PTSD). • Most sexual assaults go unreported. Three studies found 40%, 75% and 97% were unreported for people with disabilities. (Criminal Justice and Behavior, Vol. 28, No. 6, 2001) H/D People with Disabilities and Domestic/Sexual Violence • As many as 83% of women with disabilities are survivors of domestic violence or sexual assault according (National Crime Victimization Survey). • Women with disabilities had a 40 % greater risk of violence and are three times more likely to be sexually assaulted than women without disabilities. Brownridge, Douglas: ”Partner Violence Against Women with Disabilities” • Persons with cognitive disabilities had the highest risk of violent victimization.- Bureau of Justice Statistics. H/D The Masks of Trauma and Disability • Common reactions to trauma can look like a disability. • Trauma can change the way a disability manifests itself. D The Anger Umbrella • Anger is never a primary emotion, there is always something underneath… Fear Shame Guilt Frustration Isolation Embarrassment Loneliness Helplessness D Looks like, but is it? • Anger, Frustration = Aggression • Shame, Fear, Guilt, Embarrassment = Avoidance of eye contact • Fear + physical trauma = touch phobia • Fear, Isolation, Loneliness = paranoia • Sometimes trauma can lead to disability… D What could these symptoms denote? • • • • • • • • • Fearful Paranoia Memory Loss Easily Frustrated Quick to Anger Socially Withdrawn Confusion Hypervigilance Dissociation D Post-Traumatic Stress Disorder • Develops after a person is exposed to one or more traumatic events, such as sexual assault, warfare, serious injury, or threats of imminent death that result in feelings of intense fear, horror, and powerlessness. • Not everyone that experiences trauma develops PTSD. • Symptoms must last for at least one month for diagnosis and can last for a lifetime. D Advocacy Tips for PTSD • • • • Allow extra time to understand materials. Patience. Redirect attention when needed. All entrances and exits within eyesight of client. • Announcing and explaining your actions/movements beforehand. • Asking before touching, directing, etc. D Trauma and Disability • If a disability already exists, trauma can worsen it. • Behavioral changes can occur overtime. • Regardless of communication issues, a person with a disability can tell you when something is wrong. The signs will be there, learn to recognize them. D Culture is no excuse for abuse • Cultures differ in their values and beliefs about gender roles and intimate relationships, but is no excuse for physical battering or psychological abuse, which do not correspond with any culture’s ideals for intimate relationships. H Response to Victims • Regard the person as an equal. Reject the common view that the person with a disability needs to be fixed or pitied. • Respect the person’s struggle as well as her/his strength as a survivor. • Assume all people with disabilities are capable. Help each person identify her/his strengths and capabilities. Build on them. • Believe and Empower them! H Just Ask • If you make a linguistic or behavioral mistake, simply apologize and maintain your willingness to communicate. • Do not talk down to a person. • Do not ask personal questions about person’s disability. • “If you are unsure of how to act or what to say, just ask!” H Don’t be discouraged or give up… • "I've missed more than 9000 shots in my career. I've lost almost 300 games. 26 times, I've been trusted to take the game winning shot and missed. I've failed over and over and over again in my life. And that is why I succeed." • - Michael Jordan H Understanding culture • Understanding a person’s culture and belief systems can be helpful in successfully working with that person and responding appropriately. • Your response may save someone’s life… H Contact Information: Juan Carlos Vázquez, M.A., USU, CPD 435-797-6399, [email protected] Hildegard Koenig, UDVC 801-521-5544, [email protected] Debbie Dilley, UCASA 801-746-0404, [email protected] Nonie Lancaster, Human Capabilities 801-293-8891, [email protected] Mitch Moyers, DSDHH 801-573-7676, [email protected] Sachin Pavithran, CPD, USU 435-797-6572, [email protected] Marilyn Hammond, CPD, USU 435-797-3811, [email protected] M Thank you! M References • The National Center for Cultural Competence, 2004 • Storti, Craig. Figuring Foreigners Out. Nicholas Brealey Publishing, 1998. • Storti, Craig. The Art of Crossing Cultures. Nicholas Brealey Publishing, 2007. • Snow, Kathie. “People First Language.” www.disabilityisnatural.com.(2009) • Lynch & Hanson. Developing Cross Cultural Competence. 1992.