OBJECTIVES - Cultural & Linguistic Considerations: Association of State ...
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12/16/2019
Cultural & Linguistic Considerations:
Communicating with Families about their Young Children’s Development
Tawara D. Goode
Georgetown University National Center for Cultural Competence
Georgetown University Center for Excellence in Developmental Disabilities
Center for Child and Human Development
Department of Pediatrics
Georgetown University Medical Center
December 16, 2019
OBJECTIVES
Participants will:
1. Define culture and differentiate culture from race and ethnicity.
2. Examine cultural characteristics of families seeking or receiving WIC services.
3. Cite examples of cultural differences in expectations of developmental norms
for young children.
4. Examine socio‐cultural and contextual barriers in screening and early
identification.
5. List considerations for communicating with culturally and linguistically
diverse families about their young children’s development.
Slide Source:© 2019 ‐ Georgetown University National Center for Cultural Competence
112/16/2019
Culture is the learned and shared knowledge that specific groups use to generate
their behavior and interpret their experience of the world. It includes but is not
limited to:
rituals roles
communication
languages
values
relationships
thought
courtesies practices
beliefs
customs
manners of expected
interacting behaviors
Culture applies to racial, ethnic, religious, political, professional, and other social groups. It is
transmitted through social and institutional traditions and norms to succeeding generations.
Culture is a paradox, while many aspects remain the same, it is also dynamic, constantly changing.
Data Source: Gilbert, J. Goode, T., & Dunne, C., 2007. Slide Source:© 2019 ‐ Georgetown University National Center for Cultural Competence
CULTURE IS …
Comprised of beliefs about reality, how people should
interact with each other, what they know about the
world, and how they should respond to the social and
material environments in which they find themselves.
Reflected in religion, morals, customs, politics,
technologies, and survival strategies of a given group. It
affects how groups work, parent, love, marry, and
understand health, mental health, wellness, illness,
disability, and end of life.
Data Source: Gilbert, J., Goode, T. D., & Dunne, C. (2007). Cultural awareness. From the Curricula Enhancement Module Series. Washington, DC: National Center for
Cultural Competence, Georgetown University Center for Child and Human Development.
Slide Source:© 2019 ‐ Georgetown University National Center for Cultural Competence
212/16/2019
Culture …
is applicable to all peoples
is value laden & rooted in belief systems
is active & dynamic
is multilayered & multidimensional
exists at conscious & unconscious levels
is often viewed as thick, thin, or compartmentalized
provides group member identity
structures perceptions & shapes behaviors
varies in expression both among and between
individual group members
permeates every aspect of life
Goode, T. & Jones, W. Cultural Influences on Child Development: The Middle Years. In T. Gullotta T. & G. Blau (Eds.) Family Influences on Childhood Behavior and Development:
Evidence‐based Approaches to Prevention and Treatment Approaches. New York: Routledge, Taylor & Francis Group, 2008.
Slide Source:© 2019 ‐ Georgetown University National Center for Cultural Competence
What the literature is telling us
Culture is not the same as race or ethnicity.
Race is a social construct used to separate and divide the world’s peoples. There is only one
race, the human race, comprised of individuals with characteristics that are more or less similar
to others.1
Race is a construct of human variability based on perceived differences in biology, physical
appearance, and behavior. The traditional conception of race rests on the false premise that
natural distinctions grounded in significant biological and behavioral differences can be drawn
between groups.2
Ethnicity is defined as how one sees oneself and how one is seen by others as part of a group on
the basis of presumed ancestry and sharing a common destiny … common threads that may tie
one to an ethnic group include skin color, religion, language, customs, ancestry, and occupational
or regional features. Persons belonging to the same ethnic group share a unique history different
from that of other ethnic groups. Usually a combination of these features identifies an ethnic
group. For example, physical appearance alone does not consistently identify one as belonging to
a particular ethnic group.3
1 National Center for Cultural Competence. Key definitions. (2011).
2 Haynes, M. & Smedley, B. (1999). Institute of Medicine, Committee on Cancer Research among Minorities and the Medically
Underserved.
Slide Source:© 2019 ‐ Georgetown University National Center for Cultural Competence
312/16/2019
Who are families seeking
or receiving WIC services
in your state?
Slide Source:© 2019 ‐ Georgetown University National Center for Cultural Competence
ACS 2018 United States Demographic Estimates
One Race or Latino or Hispanic and Race
Total Population = 327,167,439
RACE NUMBER Percent of
POPULATION
One Race 315,887,408 96.6%
White 236,173,020 72.2%
Black or African American 41,617,764 12.7%
American Indian or Alaska Native 2,801,587 0.9%
Asian 18,415,198 5.6%
Native Hawaiian & Other Pacific Islander 626,054 0.2%
Some Other Race 16,253,785 5.0%
Two or More Races 11,280,031 3.4%
HISPANIC OR LATINO AND RACE
Hispanic or Latino of any Race 59,763,631 18.3%
Data Source: Source: U.S. Census Bureau, 2018 American Community Survey (ACS), Slide Source:© 2019 -
Demographic & Housing Estimates, Table DP05, 1-Year Estimates. Georgetown University National Center for Cultural Competence
412/16/2019
Population Self-Identified by Race & Ethnicity
Categorical Listings
White and Black or African American
White and American Indian and Alaska Native
White and Asian
White and Native Hawaiian and Other Pacific Islander
White and Some Other Race
Black or African American and American Indian and Alaska Native
Black or African American and Asian
Black or African American and Native Hawaiian and Other Pacific Islander
Black or African American and Some Other Race
American Indian and Alaska Native; Asian
American Indian and Alaska Native and Native Hawaiian and Other Pacific Islander
American Indian and Alaska Native and Some Other Race
Asian and Native Hawaiian and Other Pacific Islander
Asian and Some Other Race
Native Hawaiian and Other Pacific Islander and Some Other Race
Three or more races
Data Source: U.S. Census Bureau, American Fact Finder, Slide Source:© 2019 - Georgetown University National Center for Cultural Competence
Top 10 Countries of Birth of Lawful Permanent
Residents in the United States in 2017
Total 1,127,167
Mexico 170,581
China, People’s Republic 71,565
Cuba 65,028
India 60,394
Dominican Republic 58,520
Philippines 49,147
Vietnam 38,231
El Salvador 25,109
Jamaica 21,905
Haiti 21,824
Data Source: U.S. Department of Homeland Security, Yearbook of Immigration Statistics: 2017 Lawful Permanent Residents, Supplemental Table 1 – Persons Obtaining
Legal Permanent Resident Status by State or Territory of Residence and Region or Country of Birth: Fiscal Year 2017
Slide Source:© 2019 - Georgetown University
National Center for Cultural Competence
512/16/2019
Children under
age 5 years
comprise 6.1 of
the U.S.
population.
N = 19,957,213
Estimates for July 1, 2018
Data Source: U.S. Census Bureau, United States Quick Facts retrieved on 12/12/19 from https://www.census.gov/quickfacts/fact/table/US/AGE135218#AGE135218
Slide Source:© 2019 ‐ Georgetown University National Center for Cultural Competence
Child Poverty by Age, Race, and Ethnicity in 2017
Under 5 Years
White Black Hispanic/Latino Asian, Native Hawaiian American Indian
(non‐Hispanic) Pacific Islander Alaska Native
Number Percent Number Percent Number Percent Number Percent Number Percent
1,130,00 11.7 928,000 33.7 1,346,000 26.2 171,000 15.6 63,000 36.2
Data Source: Children’s Defense Fund, Child Poverty in America in 2017: National Analysis. Retrieved on 12/12/19 from
https://www.childrensdefense.org/wp‐content/uploads/2018/09/Child‐Poverty‐in‐America‐2017‐National‐Fact‐Sheet.pdf
Slide Source:© 2019 ‐ Georgetown University National Center for Cultural Competence
612/16/2019
POLLING QUESTION
Do you know the top five
languages spoken in your state?
□ yes □ no □ I thought I did!
Slide Source:© 2019 ‐ Georgetown University National Center for Cultural Competence
Languages Spoken at Home in the U.S. in 2018
Estimated Total Population 5 years and over 307,521,124
Speak only English 78.1%
Speak a language other than English 21.9%
Speak Spanish 41,460,427 (13.5%)
Speak Indo European languages 11,285,467 (3.7%)
[French (Patois, Cajun), French Creole, Italian, Portuguese, Portuguese Creole, German, Yiddish, Other West Germanic languages, Scandinavian
languages, Greek, Russian, Polish, Serbo‐Croatian, Other Slavic languages, Armenian, Persian, Gujarathi, Hindi, Urdu, Other Indic languages]
Speak Asian and Pacific Island languages 10,945,719 (3.6%)
[Chinese, Japanese, Korean, Mon‐Khmer, Cambodian, Miao, Hmong, Thai, Laotian, Vietnamese, Tagalog, other Pacific Island languages]
Other Languages 3,577,055 (1.2%)
[Navajo, Other Native American languages, Hungarian, Arabic, Hebrew, African languages, other unspecified languages]
Data Source: U.S. Census Bureau, American Fact Finder, 2018 American Slide Source:© 2019 - Georgetown University
Community Survey-1 Year Estimates, Table DP02 National Center for Cultural Competence
712/16/2019
Limited English Speaking Households
Limited English Speaking Households formerly (linguistic isolation) refers to households
in which no member 14 years old and over: (1) speaks only English or (2) speaks a non‐
English language and speaks English “very well.”
Limited English Speaking Households in the Unites States in 2018
All households 4.4%
Households speaking‐‐
Spanish 21.3%
Other Indo‐European languages 15.0%
Asian and Pacific Island languages 24.2%
Other languages 15.9%
Data Source: U.S. Census Bureau, American FactFinder, Slide Source:© 2019 ‐ Georgetown University
2018 American Community Survey‐ 1 Year Estimates, Table S1602 National Center for Cultural Competence
What do these demographics
look like in your state?
A quick look at Arkansas, Massachusetts, Nevada
Slide Source:© 2019 ‐ Georgetown University National Center for Cultural Competence
812/16/2019
ACS 2018 Arkansas Demographic Estimates
Total Population = 2,977,944
One Race or Latino or Hispanic and Race
RACE NUMBER % of
POPULATION
White 2,302,141 77.3
Black or African American 459,969 15.4
American Indian or Alaska Native 19,476 0.7
Asian 42,368 1.4
Native Hawaiian & Other Pacific Islander 7,062 0.2
Some Other Race 75,106 2.5
Two or More Races 71,822 2.4
HISPANIC OR LATINO AND RACE
Hispanic or Latino of any Race 213,246 7.2
Data Source: Source: U.S. Census Bureau, 2018 American Community Survey (ACS), Slide Source:© 2019 -
Demographic & Housing Estimates, Year 1 Estimates Table DP05 Georgetown University National Center for Cultural Competence
Languages Spoken at Home in Arkansas in 2018
Estimated Total Population 5 years and over 2,825,733
Speak only English 92.3%
Speak a language other than English 7.7%
Speak Spanish 154,946 (5.5%)
Speak Indo European languages 19,618 (0.7%)
[French (Patois, Cajun), French Creole, Italian, Portuguese, Portuguese Creole, German, Yiddish, Other West Germanic languages, Scandinavian
languages, Greek, Russian, Polish, Serbo‐Croatian, Other Slavic languages, Armenian, Persian, Gujarathi, Hindi, Urdu, Other Indic languages]
Speak Asian and Pacific Island languages 38,302 (1.4%)
[Chinese, Japanese, Korean, Mon‐Khmer, Cambodian, Miao, Hmong, Thai, Laotian, Vietnamese, Tagalog, other Pacific Island languages]
Other Languages 3,852 (0.1%)
[Navajo, Other Native American languages, Hungarian, Arabic, Hebrew, African languages, other unspecified languages]
Data Source: U.S. Census Bureau, American Fact Finder, 2018 American Slide Source:© 2019 - Georgetown University
Community Survey-1 Year Estimates, Table S1601 National Center for Cultural Competence
912/16/2019
Limited English Speaking Households
Limited English Speaking Households formerly (linguistic isolation) refers to households
in which no member 14 years old and over: (1) speaks only English or (2) speaks a non‐
English language and speaks English “very well.”
Limited English Speaking Households in Arkansas in 2018
All households 1.5%
Households speaking‐‐
Spanish 5.1%
Other Indo‐European languages 1.1%
Asian and Pacific Island languages 1.3%
Other languages 0.2%
Data Source: U.S. Census Bureau, American FactFinder, Slide Source:© 2019 ‐ Georgetown University
2018 American Community Survey‐ 1 Year Estimates, Table S1602 National Center for Cultural Competence
ACS 2018 Massachusetts Demographic Estimates
Total Population = 6,902,149
One Race or Latino or Hispanic and Race
RACE NUMBER % of
POPULATION
White 5,335,175 77.3
Black or African American 537,523 7.8
American Indian or Alaska Native 16,198 0.2
Asian 472,403 6.8
Native Hawaiian & Other Pacific Islander 2,775 0.0
Some Other Race 303,331 4.4
Two or More Races 234,744 3.4
HISPANIC OR LATINO AND RACE
Hispanic or Latino of any Race 846,780 12.3
Data Source: Source: U.S. Census Bureau, 2018 American Community Survey (ACS), Slide Source:© 2019 -
Demographic & Housing Estimates, Year 1 Estimates Table DP05 Georgetown University National Center for Cultural Competence
1012/16/2019
Languages Spoken at Home in Massachusetts in 2018
Estimated Total Population 5 years and over 6,544,926
Speak only English 75.7%
Speak a language other than English 24.3%
Speak Spanish 615,909 (9.4%)
Speak Indo European languages 596,805 (9.1%)
[French (Patois, Cajun), French Creole, Italian, Portuguese, Portuguese Creole, German, Yiddish, Other West Germanic languages, Scandinavian
languages, Greek, Russian, Polish, Serbo‐Croatian, Other Slavic languages, Armenian, Persian, Gujarathi, Hindi, Urdu, Other Indic languages]
Speak Asian and Pacific Island languages 284,692 (4.3%)
[Chinese, Japanese, Korean, Mon‐Khmer, Cambodian, Miao, Hmong, Thai, Laotian, Vietnamese, Tagalog, other Pacific Island languages]
Other Languages 93,467 (1.4%)
[Navajo, Other Native American languages, Hungarian, Arabic, Hebrew, African languages, other unspecified languages]
Data Source: U.S. Census Bureau, American Fact Finder, 2018 American Slide Source:© 2019 - Georgetown University
Community Survey-1 Year Estimates, Table S1601 National Center for Cultural Competence
Limited English Speaking Households
Limited English Speaking Households formerly (linguistic isolation) refers to households
in which no member 14 years old and over: (1) speaks only English or (2) speaks a non‐
English language and speaks English “very well.”
Limited English Speaking Households in Massachusetts in 2018
All households 6.1%
Households speaking‐‐
Spanish 28.5%
Other Indo‐European languages 18.5%
Asian and Pacific Island languages 26.1%
Other languages 15.9%
Data Source: U.S. Census Bureau, American FactFinder, Slide Source:© 2019 ‐ Georgetown University
2018 American Community Survey‐ 1 Year Estimates, Table S1602 National Center for Cultural Competence
1112/16/2019
ACS 2018 Nevada Demographic Estimates
Total Population = 3,034,392
One Race or Latino or Hispanic and Race
RACE NUMBER % of
POPULATION
White 1,924,976 63.4
Black or African American 280,385 9.2
American Indian or Alaska Native 44,666 1.5
Asian 250,137 8.2
Native Hawaiian & Other Pacific Islander 19,612 0.6
Some Other Race 358,786 11.8
Two or More Races 155,830 5.1
HISPANIC OR LATINO AND RACE
Hispanic or Latino of any Race 881,145 29.0
Data Source: Source: U.S. Census Bureau, 2018 American Community Survey (ACS), Slide Source:© 2019 -
Demographic & Housing Estimates, Year 1 Estimates Table DP05 Georgetown University National Center for Cultural Competence
Languages Spoken at Home in Nevada in 2018
Estimated Total Population 5 years and over 2,849,853
Speak only English 69.1%
Speak a language other than English 30.9%
Speak Spanish 606,278 (21.3%)
Speak Indo European languages 70,082 (2.5%)
[French (Patois, Cajun), French Creole, Italian, Portuguese, Portuguese Creole, German, Yiddish, Other West Germanic languages, Scandinavian
languages, Greek, Russian, Polish, Serbo‐Croatian, Other Slavic languages, Armenian, Persian, Gujarathi, Hindi, Urdu, Other Indic languages]
Speak Asian and Pacific Island languages 172,176 (6.0%)
[Chinese, Japanese, Korean, Mon‐Khmer, Cambodian, Miao, Hmong, Thai, Laotian, Vietnamese, Tagalog, other Pacific Island languages]
Other Languages 33,204 (1.2%)
[Navajo, Other Native American languages, Hungarian, Arabic, Hebrew, African languages, other unspecified languages]
Data Source: U.S. Census Bureau, American Fact Finder, 2018 American Slide Source:© 2019 - Georgetown University
Community Survey-1 Year Estimates, Table S1601 National Center for Cultural Competence
1212/16/2019
Limited English Speaking Households
Limited English Speaking Households formerly (linguistic isolation) refers to households
in which no member 14 years old and over: (1) speaks only English or (2) speaks a non‐
English language and speaks English “very well.”
Limited English Speaking Households in Nevada in 2018
All households 5.8%
Households speaking‐‐
Spanish 20.7%
Other Indo‐European languages 9.9%
Asian and Pacific Island languages 17.6%
Other languages 18.1%
Data Source: U.S. Census Bureau, American FactFinder, Slide Source:© 2019 ‐ Georgetown University
2018 American Community Survey‐ 1 Year Estimates, Table S1602 National Center for Cultural Competence
POLLING QUESTION
What do you know about the literacy levels of
the families seeking or receiving WIC services in
your state?
□ not at all familiar
□ slightly familiar
□ somewhat familiar
□ moderately familiar
□ extremely familiar
Slide Source:© 2019 ‐ Georgetown University National Center for Cultural Competence
1312/16/2019
A Word About Health Literacy
Some families may be able to read, however, they may be
unfamiliar with certain concepts and words on the Learn the
Signs Act Early Checklist such as:
Babble
Gurgling
Vowels
Gestures
This may be even more challenging for families whose first
language is not English or who are monolingual in their
language of origin.
Slide Source:© 2019 ‐ Georgetown University National Center for Cultural Competence
POLLING QUESTION
Of the families seeking or receiving WIC services, how much do you
know about the cultural expectations of typical child development
ages (birth ‐ five years)?
□ not at all familiar
□ slightly familiar
□ somewhat familiar
□ moderately familiar
□ extremely familiar
Slide Source:© 2019 ‐ Georgetown University National Center for Cultural Competence
1412/16/2019
CULTURE MATTERS
“Cross‐cultural comparisons show that virtually all
aspects of infant development and parenting are
informed by culture: Culture influences who, when,
and how to care for children, what parents expect
of children, and which behaviors parents should
encourage and reward or discourage and punish.”
Bornstein, M. H. Culture, Parenting, and Zero‐to‐Threes. Zero Three. March; 35(4) 2‐9.
Slide Source:© 2019 ‐ Georgetown University National Center for Cultural Competence
CULTURE INFLUENCES DEVELOPMENT & DEVELOPMENTAL EXPECTATIONS
The literature tells us there are cultural difference in expectations of
developmental norms for infants and young children.
“Culturally informed research suggests that psychomotor development
infants is not driven exclusively by biological forces but rather is shaped
systematically by childrearing practices that vary by culture.”1
While there is variance in expectation for development of social
interaction and behavioral skills across racial and ethnic groups, there is
greater concordance in expectations related to motor development.
1 Bornstein, M. H. Culture, Parenting, and Zero‐to‐Threes. Zero Three. March; 35(4) 2‐9.
Slide Source:© 2019 ‐ Georgetown University National Center for Cultural Competence
1512/16/2019
CULTURE INFLUENCES DEVELOPMENT & DEVELOPMENTAL EXPECTATIONS
“Be mindful of cultural differences. Not all cultures place the same
emphasis on particular developmental milestones.”1
Some families may not have a shared understanding and acceptance of
the milestones that are used to assess infants and young children. Their
perceptions of when young children develop certain skills and abilities
may be based on cultural norms or family experience.
“My brother didn’t speak until he was three years old and he turned out OK.”
“Boys are always slower. Its nothing to worry about.”
“Her grandmother babies her and does everything for her. She hasn’t had to do
anything for herself.”
This begs the question, who are credible voices within some cultural communities?
1 CDCLearn the Signs Act Early. Tips for talking with parents about developmental concerns. Retrieved on 12/12/19
from https://www.cdc.gov/ncbddd/actearly/pdf/CDC_LTSAE_TipsForTalkingWithParents_AppBadge‐508.pdf
Slide Source:© 2019 ‐ Georgetown University National Center for Cultural Competence
CULTURAL EXPERIENCES INFLUENCE TRUST IN HEALTH PROFESSIONALS
Even though the American Academy of Pediatrics endorses the LTSAE
checklists, some families may or may not have trust in these tools. This
may be based on their experiences (past and current) or those of
extended family members and friends. Distrust may also be based on
experiences of stereotyping, disrespect or discrimination (actual or
perceived), marginalization, and the hoops low income people have to
jump through to receive public benefits.
Bias in assessment and testing is well‐documented in the literature. No
screening instrument is culturally neutral. LTSAE tools are based on the
unique cultural norms of U.S. and western societies.
1 CDCLearn the Signs Act Early. Tips for talking with parents about developmental concerns. Retrieved on 12/12/19
from https://www.cdc.gov/ncbddd/actearly/pdf/CDC_LTSAE_TipsForTalkingWithParents_AppBadge‐508.pdf
Slide Source:© 2019 ‐ Georgetown University National Center for Cultural Competence
1612/16/2019
POLLING QUESTION
Of the families seeking or receiving WIC services, how much
do you know about culturally-defined beliefs of families about
what it means for a child to have developmental delay or
disability?
□ not at all familiar
□ slightly familiar
□ somewhat familiar
□ moderately familiar
□ extremely familiar
Slide Source:© 2019 ‐ Georgetown University National Center for Cultural Competence
WHAT DOES HAVING A DEVELOPMENTAL PROBLEM MEAN IN A CULTURAL CONTEXT?
Cultural beliefs and experiences (historical and present day) influence
what it means to be suspected of or have a developmental delay or
disability. Factors include:
Race
Ethnicity particularly as it relates to speaking a language other than
English or ASL.
Socio‐economic status
Immigration status
Stigma
Religion and spirituality
Disparities in diagnoses
Information dissemination including what and how information about
developmental delay or disability and particularly autism is conveyed
and understood within diverse communities.
Slide Source:© 2019 ‐ Georgetown University National Center for Cultural Competence
1712/16/2019
Cultural Considerations in Communicating with Families
about their Young Children’s Development
1. Your own self‐awareness. Consider asking the questions: Who is uncomfortable with the
conversation you or the parent? Do you convey your own anxiousness to the family? Do you tend to
make assumptions about the WIC population in your state? Are you aware of your own biases?
2. Put yourself in the parent’s/family’s place. How hard is it for any parent to hear that something may
be wrong with their child? Consider the range of reactions that any parent may have from shock,
denial, anger, sadness, and relief (because they knew instinctively something was not right). Also
consider culturally what it means to have a developmental problem and the associated historical
issues.
3. Biases go both ways. Because of past or present day experiences, some families may feel biased
toward public benefits. Some providers of public benefits may have implicit biases about the
populations they serve. These biases may manifest in screening encounters and compromise
communication.
4. Building trust takes time. Engendering trust among families who have been labeled and
marginalized in a long‐term effort. Concentrate on being your authentic self as a public health
practitioner committed to serving all communities.
Slide Source:© 2019 ‐ Georgetown University National Center for Cultural Competence
Cultural Considerations in Communicating with Families
about their Young Children’s Development
5. Know the law and know your role when using an interpreter. Interpersonal dynamics change when
you are using an interpreter Some families will require screening and all information to be in their
language of origin. As a recipient of Federal funds, your agency is responsible for ensuring language
access for individuals and families who have limited English proficiency. You should be familiar with
your agency’s or program’s policy (Language Access and Implementation Plan) and how to work
effectively with an interpreter (practices).
6. All communication is cross‐cultural. As humans, we are all cultural beings. When we interact with
others it is a cross‐cultural experience even if those who are communicating are from the same race,
ethnicity, gender, or culture. Since we are human, mistake making is a fact of life. Learn to accept
that all of us make mistakes in cross‐cultural communication. Learn from mistakes and leave the guilt
behind – avoid getting stuck. Families need, depend upon, and appreciate your best self.
Slide Source:© 2019 ‐ Georgetown University National Center for Cultural Competence
1812/16/2019
As a culturally competent _________
I am capable of interacting positively with
people who do NOT
look like,
communicate like,
move like,
think like,
believe like,
act like,
love like,
live like,
Source: Multnomah County Department of Health.
ME!!!
Slide Source:© 2019
Modification from Mike Magy, Massachusetts Department of Mental Georgetown University National Center for Cultural Competence
Health, November 2005 .
CONTACT US
Georgetown University National Center for Cultural Competence
http://nccc.georgetown.edu
cultural@georgetown.edu
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