A Toolkit for Serving Diverse Communities - Administration on Aging

A T o o l k i t f o r S e r v i n gD i v e r s e C o m m u n i t i e sU . S . A D M I N I S T R A T I O N O N A G I N G

T a b l e o f C o n t e n t sPreface 2Foreword 3Acknowledgements 4Introduction 6Illustration: The Steps of Planning Services <strong>for</strong> <strong>Diverse</strong> <strong>Communities</strong> 7P A R T IStep 1: AssessmentsIntroduction to Step 1 8Presentation 9<strong>Diverse</strong> Community Questionnaire 12Step 2: Identifying Resources About the CommunityIntroduction to Step 2 16Presentation 17<strong>Diverse</strong> Community Questionnaire 20Step 3: Designing ServicesIntroduction to Step 3 24Presentation 25<strong>Diverse</strong> Community Questionnaire 28Step 4: Program EvaluationIntroduction to Step 4 32Presentation 33<strong>Diverse</strong> Community Questionnaire 38P A R T I I : A P P E N D I C E SAppendix A: <strong>Diverse</strong> Community Questionnaire 42Appendix B: Definitions 54Appendix C: Diversity Concepts 56Appendix D: Discussion Scenarios 58Appendix E: Companion Presentations 66Appendix F: Companion Exercises 104Appendix G: List of Online Resources 108Appendix H: Diversity Training Tips 128A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 1

P r e f a c eG O L D E N R U L E .Treat others the way you want to be treated.P L A T I N U M R U L E * .Treat others the way they want to be treated.So often as professionals, we unwittingly useour own culture and values as a measuringstick to determine how and why we treatpeople the way we do. We frequently <strong>for</strong>getto ask ourselves, “How does this person wantto be treated, not based on my values andculture, but theirs?” Or, “Do I even know theirculture and values well enough to know if I’mtreating them with respect?” These questions,which are the basis of ethical humaninteraction, are also at the core of providingquality service.Although it might not seem obvious thatwe should treat people the way they wantto be treated and not the way individuals,institutions, or systems want to treat them, wecan change how we view people of differentcultures. Helping to facilitate this change is thepurpose of this <strong>Toolkit</strong>.This <strong>Toolkit</strong> is an invitation to make a culturalshift in your perspective: to learn, to grow,and to fully appreciate the people you havededicated your career to serving. And youdon’t have to do it alone. Making a culturalshift takes partnership and collaboration.This <strong>Toolkit</strong> supports the full participation ofprofessionals, their agencies, and partners towork together to serve all diverse populationswith respect, inclusiveness, and sensitivity.* Bennett, M. J. 1998. “Overcoming the golden rule: Sympathy and empathy” in M. J Bennett 1998 Basic concepts ofintercultural communication: Selected readings. Yarmouth, ME: Intercultural Press.2U . S . A D M I N I S T R A T I O N O N A G I N G

F o r e w o r dAs the National Aging Services Network continues to meet the needs and expectations ofincreasingly culturally and ethnically varied populations, a better understanding of culturaldifferences and their relationship to the hallmarks of quality service—respect, inclusiveness, andsensitivity—becomes essential. <strong>Serving</strong> diverse populations, after all, is not a “one size fits all”process. Diversity includes all differences, not just those that indicate racial or ethnic distinctions.And addressing the needs and concerns of specific service populations—African-American, Asian-American, American Indian, Hispanic, as well as older adults with disabilities, immigrant elders,and lesbian, gay, bisexual, and transgender (LGBT) older adults—begins with asking appropriateand timely questions.This <strong>Toolkit</strong> provides Aging Agencies and their state and local partners with a starting point<strong>for</strong> conversations regarding how to better serve diverse populations of older adults. It is hopedthat the dissemination and use of this <strong>Toolkit</strong> will enhance Older Americans Act services.Additionally, it is anticipated that this product will facilitate broader interest in developing othercommunity-based tools and strategies that improve services <strong>for</strong> all populations and build thenetwork’s value and expertise in advocating <strong>for</strong> and supporting older adult Americans, theirfamilies, and caregivers.Kathy GreenleeAssistant Secretary <strong>for</strong> AgingA T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 3

A c k n o w l e d g e m e n t sWe would like to thank and acknowledge the following individuals <strong>for</strong> dedicating theirtime and energy to this project as reviewers. Treat others the way they want to be treated.Greg CaseAging Program SpecialistOffice of Planning and Policy DevelopmentU.S. <strong>Administration</strong> on AgingU.S. Department of Health and Human ServicesCarol CrecyDirector of CommunicationsOffice of CommunicationsU.S. <strong>Administration</strong> on AgingU.S. Department of Health and Human ServicesTina HoweWeb Content ManagerDB Consulting Group, Inc.David A. IshidaRegional Administrator, Regions IX & XU.S. <strong>Administration</strong> on AgingU.S. Department of Health and Human ServicesFaith T. McCormickActing Commissioner<strong>Administration</strong> on Developmental Disabilities<strong>Administration</strong> <strong>for</strong> Children and FamiliesU.S. Department of Health and Human ServicesE. Percil Stan<strong>for</strong>d, Ph.D.Sr. Vice President and Chief Diversity OfficerOffice of Diversity and InclusionAARPOmar R. Valverde, Esq.Office of Elder RightsU.S. <strong>Administration</strong> on AgingU.S. Department of Health and Human ServicesSherri ClarkAging Services Program SpecialistOffice of CommunicationsU.S. <strong>Administration</strong> on AgingU.S. Department of Health and Human ServicesCommander David A. DietzSenior Public Health AnalystOffice of Minority HealthOffice of Public Health and ScienceU.S. Department of Health and Human ServicesBernice HutchinsonDiversity Policy ConsultantDarrick Lam, M.S.W.Aging Services Program SpecialistU.S. <strong>Administration</strong> on AgingU.S. Department of Health and Human ServicesAnthony SarmientoExecutive DirectorSenior Service America, Inc.Carmelita TursiProgram ManagerOffice of Diversity and InclusionAARPJose VelascoAging Services Program SpecialistOffice of Regional OperationsU.S. <strong>Administration</strong> on AgingU.S. Department of Health and Human ServicesA special thanks to Leslie Swann, Ph.D., U.S. <strong>Administration</strong> on Aging, Program Specialist, <strong>for</strong> her dedicationand energy in the conceptualization and development of this <strong>Toolkit</strong>.4U . S . A D M I N I S T R A T I O N O N A G I N G

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A T O O L K I T F O R S E R V I N GD I V E R S E C O M M U N I T I E SI n t r o d u c t i o nWhat is the <strong>Toolkit</strong> <strong>for</strong> <strong>Serving</strong> <strong>Diverse</strong> <strong>Communities</strong>?The <strong>Toolkit</strong> consists of a four-step process and aquestionnaire that assists the Aging Services Networkand its partners with every stage of program planning,implementation, and delivery of diverse populationservices. The four steps are (1) Assessments,(2) Identifying Resources About the Community,(3) Designing Services, and (4) Program Evaluation.The <strong>Diverse</strong> Community Questionnaire providesquestions to assist agency staff through each step ofthe process (see Appendix A). These questions enableagencies and their partners to consider how to improveservices <strong>for</strong> diverse communities.What is the goal of the <strong>Toolkit</strong>?The goal of the <strong>Toolkit</strong> is to provide the Aging Networkwith a replicable and easy-to-use method <strong>for</strong> providingrespectful, inclusive, and sensitive services <strong>for</strong> anydiverse community.Who should use this <strong>Toolkit</strong>?This <strong>Toolkit</strong> should be used by the Aging Network andits partners. This includes professionals who servein a broad range of roles while assisting older adultsand their families. Besides directors and managersof State Units on Aging (SUAs) and Area Agencieson Aging (AAAs), program managers, policy advisors,in<strong>for</strong>mation specialists, outreach workers, optionscounselors, ombudsmen, and many others may findthis <strong>Toolkit</strong> useful.How should the <strong>Toolkit</strong> be used?The <strong>Toolkit</strong> should be used to help agencies andtheir partners to start a conversation on how toprovide better services <strong>for</strong> diverse communities. Thatconversation begins with the <strong>Diverse</strong> CommunityQuestionnaire that provides a series of questions toaddress which pieces may be missing from services.The questionnaire allows an agency and its partners todesign service plans based on their own experiencesand stages of learning in the process of serving diversecommunities better.What are the principles of the <strong>Toolkit</strong>?1. Respect, inclusion, and sensitivity are thehallmarks of quality service.2. Delivering outreach and services based on thepopulation’s values and perceptions is at the coreof successful service delivery.3. <strong>Serving</strong> diverse populations is not a “one sizefits all” process. It involves asking the rightquestions to help address the needs andconcerns of any population.4. The meaning of diversity goes beyond race andethnicity. It includes individuals with disabilities;lesbian, gay, bisexual, and transgender (LGBT)older adults; homeless seniors; older adultimmigrants; and many other populations.5. Diversity is all around us. It is a part of daily lifeand offers us opportunities to grow and learnabout others.6U . S . A D M I N I S T R A T I O N O N A G I N G

T H E S T E P S O F P L A N N I N G S E R V I C E SF O R D I V E R S E C O M M U N I T I E SS T E P 1 : AssessmentsS T E P 2 : Identifying ResourcesAbout the Community• Organizational assessment: policies,procedures, bylaws, and communityperceptions• Staff assessment: knowledge, skills,and practices• Self-assessment: personal attitudes,beliefs, and behaviors• Agency knowledge of the servicecommunity• Partnerships and coalitions withrepresentatives from diverse groups• Client and community data• Client input• Delivery of services through marketingand outreach• Organization and client evaluationof services• Lessons learned• Service recipients: clients, caregivers, andcommunity organizations• Types of services to be delivered• Time and location of service delivery• Barriers to service delivery and accessS T E P 4 : Program EvaluationS T E P 3 : Designing ServicesA T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 7

S T E P 1 : A S S E S S M E N T SI n t r o d u c t i o nPurposeThe purpose of this step is to encourage discussionof the significance of organizational, staff, and selfassessmentconcerning your agency’s readiness andcapacity to serve diverse communities.SummaryThis section explains Step 1 by providing briefquestions, answers, and discussion points. Thisin<strong>for</strong>mation can assist your agency and its partnerswith understanding the value of assessments thatidentify gaps in agency capacity and knowledgeregarding diverse communities.Per<strong>for</strong>ming in-depth assessments is the first stepin serving diverse populations. It is critical <strong>for</strong>your agency to understand what types of skillsand knowledge you have and what types of skillsand knowledge you will need to add to serve acommunity with a diverse population.Core Learning QuestionWhat types of experiences, resources, and knowledgedo your agency and its partners have with providingservices to diverse communities?Supplemental <strong>Toolkit</strong> Resources <strong>for</strong> Step 1To learn more about assessments, see:Appendix G: List of Online Resources <strong>for</strong> Step 18U . S . A D M I N I S T R A T I O N O N A G I N G

P R E S E N T A T I O N : T H E S T E P S O F P L A N N I N GS E R V I C E S F O R D I V E R S E C O M M U N I T I E SS T E P 1 : Assessments• Organizational assessment: policies,procedures, bylaws, and communityperceptions• Staff assessment: knowledge, skills,and practicesS T E P 2 : Identifying ResourcesAbout the Community• Self-assessment: personal attitudes,beliefs, and behaviorsS T E P 4 : Program EvaluationS T E P 3 : Designing ServicesAssessments should be provided at everyagency level.Your agency can conduct its own assessments. However,some experts recommend that a third-party consultantconduct assessments. A consultant can ensure objectivityand reduce staff anxieties about confidentiality.Assessments can answer questions such as:• What skills do we have?• What skills do we need?• How and where can we get those skills?A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S

O R G A N I Z A T I O N A LA S S E S S M E N TWho?The agency.Why?Provides a process to assess the policies, procedures,mission statements, and community perceptions of anagency.Value?Helps design a <strong>for</strong>mal plan to assess, review, andrevise policies and procedures to make them culturallyresponsive <strong>for</strong> the agency’s service populations. It alsohelps align policy with practice.It is not enough to simply train staff memberswithout considering how policies directly impactthe service delivery needs of diverse communities.Organizational assessments can help your agencyunderstand how policies, procedures, and missionstatements are aligned with service populations’ideas of quality services and delivery.S T A F F A S S E S S M E N TWho?All staff, managers, board members, committeemembers, consumer boards, and volunteers—anyonewho influences policy and provides services.Why?Provides a process to assess the knowledge, skills, andpractices of staff and helps identify gaps in knowledgeand practice.Value?Helps design a <strong>for</strong>mal plan to establish goals and setmilestones <strong>for</strong> staff education. Provides an opportunity<strong>for</strong> open dialog regarding staff attitudes about servingdiverse communities.Staff assessments help your agency understandgaps in collective staff knowledge.Staff assessments can be used as tools toprovide a comprehensive picture of youragency’s skills and assets in serving diversecommunities.1 0U . S . A D M I N I S T R A T I O N O N A G I N G

S E L F - A S S E S S M E N TWho?All staff, managers, board members, committeemembers, consumer boards, and volunteers—anyonewho influences policy and provides services.Why?Provides a confidential process <strong>for</strong> an individualto assess personal attitudes, behaviors, and beliefsconnected with serving diverse communities.Self-assessments provide a confidential, individualmeasurement of a person’s com<strong>for</strong>t withinteracting with members of diverse communities.Value?Helps establish personal milestones <strong>for</strong> gainingknowledge and acquiring a level of com<strong>for</strong>t withserving diverse communities.A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 1 1

S T E P 1 : A S S E S S M E N T SD i v e r s e C o m m u n i t yQ u e s t i o n n a i r eThe <strong>Diverse</strong> Community Questionnaire is a tool that allows your agency, its partners, and stakeholders to have aconversation about what respectful, inclusive, and sensitive services are to a particular community. We encourageyour agency to use this tool with flexibility, and tailor this questionnaire to meet the particular needs of thecommunities it serves.Target Population:________________________________________________________________________________________What is the service population’sneighborhood/community location?________________________________________________________________________________________Organizational, staff, and self-assessments allow anagency to understand its collective experience andknowledge about a particular community. Whetheryour agency wants to improve its services <strong>for</strong> aspecific group or wants to establish a visible andtrusted presence in a neighborhood, the questionsbelow help your agency understand how assessmentsprovide a comprehensive snapshot of your ability toprovide services <strong>for</strong> that community.1 2U . S . A D M I N I S T R A T I O N O N A G I N G

Has your agency provided services to this community?Yes NoIf yes, did your agency include this community’sperspectives in its planning of program missionstatements, policies, and procedures?If no, what steps does your agency plan to take toinclude this community in its planning of programmission statements, policies, and procedures (e.g.,consumer advisory boards, community advisorycouncils, advocacy groups)?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________If your agency has served or currently serves thiscommunity, what did it learn about the communitythat could be helpful in providing better services?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________If your agency has served or currently serves thiscommunity, what feedback has it received about thiscommunity’s perspectives of your services?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________How can your agency improve or enhance thisperspective?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Are any of your agency’s staff, board members,committee members, and/or consumer advisory-boardmembers from this community?Yes NoIf yes, what knowledge and skills do they have that canhelp your agency better serve this population?_______________________________________________________________________________________________________________________________________________________________________________________________________________________________A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 1 3

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________If no, what steps does your agency plan to take toprovide representation from this community whileoffering services to its older adult population?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Have any of your staff had experience serving thispopulation, either with your agency or with otheragencies? Yes NoIf yes, what knowledge and skills did they gain to helpyour agency provide better services to this population(e.g., bilingual skills, established relationships withtrusted community organizations, knowledge ofneighborhood advisory board members)?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________How do individual staff members characterize thiscommunity (e.g., difficult to serve, in<strong>for</strong>mal caregivingnetwork)?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What is this characterization based on (e.g., data,feedback from individuals outside of the population’scommunity, feedback from individuals within thepopulation’s community, service providers, staffobservation)?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________1 4U . S . A D M I N I S T R A T I O N O N A G I N G

Additional Notes:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 1 5

S T E P 2 : I D E N T I F Y I N GR E S O U R C E S A B O U TT H E C O M M U N I T YI n t r o d u c t i o nPurposeThe purpose of this step is to foster discussion onidentifying resources that can help your agency findreliable in<strong>for</strong>mation on diverse communities.SummaryThis section explains Step 2 by providing briefquestions, answers, and discussion points. Thisin<strong>for</strong>mation can help your agency identify a variety ofreliable and factual resources about the characteristicsof a particular community.Part of providing quality services is finding outas much in<strong>for</strong>mation as your agency can about aparticular diverse community.Understanding the community’s needs and valuescan help your agency develop more appropriateand valuable services.Core Learning QuestionWhat resources can assist your agency with gainingknowledge about a particular community?Supplemental <strong>Toolkit</strong> Resources <strong>for</strong> Step 2To learn more about identifying resources, see:Appendix E: Companion Presentations• Factors that Influence Culture• World ViewAppendix G: List of Online Resources <strong>for</strong> Step 21 6U . S . A D M I N I S T R A T I O N O N A G I N G

P R E S E N T A T I O N : T H E S T E P S O F P L A N N I N GS E R V I C E S F O R D I V E R S E C O M M U N I T I E SS T E P 2 : Identifying ResourcesAbout the Community• Agency knowledge of the servicecommunityS T E P 1 : Assessments• Partnerships and coalitions withrepresentatives from diverse groups• Client and community data• Client input• S T E P 4 : Program Evaluation• S T E P 3 : Designing ServicesIdentifying resources about a service population can answer questions such as:• What do we need to know about this population?• What groups does this population trust?• What types of data can help us improve our services?A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 1 7

A G E N C Y K N O W L E D G E O F T H ES E R V I C E C O M M U N I T YWho?All staff, board members, committee members,partnering agencies, and volunteers.Why?Ensures that an agency understands the communityit is serving.Value?The agency’s staff can find out the values ofthe community to tailor its services to meet thecommunity’s needs.Your agency and its staff can gain knowledge abouta service population by reviewing assessments tofind out what types of experiences you already havewith a particular community. Also look to your boardmembers, volunteers, and partners that work in theclient’s community <strong>for</strong> their levels of expertise.Managers should track staff’s previous and currentexperiences in working with diverse communities.Some types of relevant knowledge and skills, suchas knowledge of trusted community organizationsor bilingualism, can be invaluable and provideopportunities <strong>for</strong> cultural brokering and peer-topeertraining.P A R T N E R S H I P S A N D C O A L I T I O N SW I T H R E P R E S E N T A T I V E SF R O M D I V E R S E G R O U P SWho?Trusted and valued representatives from diverseservice areas.Why?Creates an opportunity to gain credibility throughassociation with individuals and groups the diversecommunity trusts.Value?Provides an authentic opportunity <strong>for</strong> learning: crosstraining,consulting, and providing collaborative services.Build partnerships effectively by learning the art ofthe “hand-shake meeting.”• Let the potential partner know you have anauthentic interest in serving the community.• Have something to offer. If the potential partneris valuable to your agency, then how can youragency be of value to the potential partner?• Focus on commonalities: “We all want to worktogether to serve this community.”Partners can play key roles in helping your agencylearn about a community:• Cross trainings• Collocation of services• Seminars, webinars, teleconferences, brown baglunch exchanges• Site visits (physical and virtual)1 8U . S . A D M I N I S T R A T I O N O N A G I N G

Make sure the service community trusts these partners by understanding the difference between those who areperceived as trusted inside a service population’s community versus those merely perceived as trusted from outsideof the community.C L I E N T D A T AWho?Aging agencies, research partners, local collegesand universities, research firms, and local, state,and Federal agencies.Why?Determines the best types of services <strong>for</strong> aparticular community.Value?Increases understanding of the types of servicesto administer that can save time and energy byavoiding costly mistakes.In addition to trusted community groups, theseorganizations may also be helpful in identifyingsources of in<strong>for</strong>mation on diverse communities:• Colleges and universities• Research firms• Local, state, and Federal agenciesWebsites, fact sheets, email lists, and newslettersare all valuable resources that can help youragency and its staff obtain the latest in<strong>for</strong>mation ondata and trends.C L I E N T I N P U TWho?Older adults, their families, and caregivers who willreceive the services.Why?Reveals how consumer expectations and valuesrelate to service provision.Value?Understanding what types of services diversecommunities value and delivering those servicescan enhance and improve an agency’s reputationand trustworthiness within a community.Client input can provide a realistic snapshot of theservice population’s needs and expectations.Client input can come from consumer advisoryboards, focus groups, surveys, interviews, casestudies, and other sources.A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 1 9

S T E P 2 : I D E N T I F Y I N G R E S O U R C E SA B O U T T H E C O M M U N I T YD i v e r s e C o m m u n i t yQ u e s t i o n n a i r eThe <strong>Diverse</strong> Community Questionnaire is a tool that allows your agency, its partners, and stakeholders to have aconversation about what respectful, inclusive, and sensitive services are to a particular community. We encourageyour agency to use this tool with flexibility, and tailor this questionnaire to meet the particular needs of thecommunities it serves.Target Population:________________________________________________________________________________________What is the service population’sneighborhood/community location?________________________________________________________________________________________Knowing where to find accurate in<strong>for</strong>mation abouta service community is invaluable when planningservice delivery. The questions in Step 2 assist youragency with identifying resources, (such as data,research, and studies) that help it understand thecharacteristics of the service population (such asfamily structure, community resources, and healthdisparities). Understanding the characteristics of aservice population prepares your agency <strong>for</strong> Step 3,Designing Services.2 0U . S . A D M I N I S T R A T I O N O N A G I N G

Which resources does your agency’s staff use to obtaincurrent in<strong>for</strong>mation and training on providing servicesto this population?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Has your agency offered staff opportunities to learnabout this particular population? Yes NoIf yes, please describe how these learning opportunitiescan help your agency provide better services to thispopulation.________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Can staff identify additional training or technicalassistance that would be helpful in serving thispopulation?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Which organizations, including current partners,can assist your agency and staff with learning howbest to serve this population? (As you think aboutthese organizations, consider whether or not they areorganizations that are visible, respected, and trusted bythe community your agency serves.)_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What do national, state, and local data reveal aboutthe needs of this community (e.g., education, income,living arrangements)?U.S. Census Bureau: www.census.govAoA Aging Statistics: www.aoa.gov/AoARoot/Aging_Statistics/index.aspx_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 2 1

What do disease and illness (morbidity) data revealabout the needs of this population?AoA statistics: www.aoa.gov/AoARoot/Aging_Statistics/index.aspxAHRQ National Healthcare Quality & DisparitiesReports: www.ahrq.gov/qual/qrdr08.htmCDC National Health Statistics home page:www.cdc.gov/nchs______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Based on state and community level data andcommunity partners, how would your agencycharacterize the following? These answers mightchange as your agency gets more in<strong>for</strong>mationfrom partners and verifies this in<strong>for</strong>mation with thecommunity.a. Community-based supports(e.g., family, church, grassroots organizations)Good Fair Poorb. Social service resourcesGood Fair Poorc. Environmental conditions(e.g., pollution/air quality)Good Fair Poord. Public transportationGood Fair Poore. Economic stabilityGood Fair Poorf. Opportunities <strong>for</strong> community involvement(e.g., socialization, volunteerism, clubs)Good Fair PoorHow does this in<strong>for</strong>mation (a – f) influence the typesof services your agency provides <strong>for</strong> this population?_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Community’s most common family structure:Nuclear Extended Other:____________________________________________________What are this community’s religious/spiritual beliefsand practices?__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________2 2U . S . A D M I N I S T R A T I O N O N A G I N G

How will these religious/spiritual beliefs and practicesinfluence the services your agency provides?_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________These answers might change as your agency gets morein<strong>for</strong>mation from partners and verifies this in<strong>for</strong>mationwith the service population.Check all that apply:______ Decisions are made by the client.______ Decisions are made by the client and familymember(s) (adult children/spouse/partner).______ Decisions are made by the group consensusof various loved ones.______ Decisions are made by another (in the caseof homelessness, mental health issues,guardianship).______ Females are the primary caretakers in thiscommunity.______ Males are the primary caretakers in thiscommunity.______ Adult children are the primary caretakers inthis community.______ Spouses/partners are the primary caretakersin this community.______ Caretakers could be any loved one and/orindividual in the community.______ Another provides primary care (in the caseof homelessness, mental health issues,guardianship).What are the primary languages (including signlanguage) of this community?__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Is this population historically an immigrantcommunity? Yes NoIf yes, how will the issue of immigration influencethe types of services your agency provides (e.g., legalservices, housing, employment?__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What are your agency’s plans to ensure that clientinput is used in the planning of services and theirdelivery (e.g., focus groups, interviews, consumeradvisory boards, surveys)?________________________________________________________________________________________________________________________________________________________________________________________________________________A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 2 3

S T E P 3 : D E S I G N I N GS E R V I C E SI n t r o d u c t i o nPurposeThe purpose of this step is to facilitate discussionabout issues that should be considered when planningservices <strong>for</strong> diverse communities.SummaryThis section explains Step 3 by providing questions,answers, and discussion points. This in<strong>for</strong>mation canhelp your agency consider what kinds and types ofservices are appropriate <strong>for</strong> a particular group.Core Learning QuestionHow should your agency design respectful, inclusive,and sensitive services <strong>for</strong> this specific community?Appendix F: Companion Exercises• Technical or Operational Knowledge• Structural or Cultural Barriers toAccessing ServicesAppendix G: List of Online Resources <strong>for</strong> Step 3Using the in<strong>for</strong>mation your agency has gatheredin Steps 1 and 2 of this process is critical whendesigning services <strong>for</strong> diverse communities.• Your assessments help your agency identifyexperience and knowledge gaps.• The resources you identify about thecommunity can help fill these gaps.Supplemental <strong>Toolkit</strong> Resources <strong>for</strong> Step 3For more in<strong>for</strong>mation on designing services, see:Appendix D: Discussion ScenariosAppendix E: Companion Presentations• Acculturation• Barriers to <strong>Serving</strong> <strong>Diverse</strong> <strong>Communities</strong>2 4U . S . A D M I N I S T R A T I O N O N A G I N G

P R E S E N T A T I O N : T H E S T E P S O F P L A N N I N GS E R V I C E S F O R D I V E R S E C O M M U N I T I E SS T E P 1 : AssessmentsS T E P 2 : Identifying ResourcesAbout the Community• Delivery of services through marketingand outreach• S T E P 4 : Program Evaluation• Service recipients: clients, caregivers, andcommunity organizations• Types of services to be delivered• Time and location of service delivery• Barriers to service delivery and accessS T E P 3 : Designing ServicesThe topics covered in Step 3 help your agency design services based on the hallmarks of quality service: respect,inclusiveness, and sensitivity.A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 2 5

D E S I G N I N G S E R V I C E SHow should services be designed and deliveredto this population?Colors, language, images, pictures; with the assistanceof family and/or life partners, caregivers, communityorganizations, etc.Who should receive your agency’s services?Clients, caregivers, community organizations, etc.What types of services should be delivered, and whichservices are most valued and appreciated?Caregiver support, meals, older adult activity centers,transportation, medication management, healtheducation, etc.When is service delivery the most valued?Social activities during holidays, meals at the end ofthe month, energy assistance during summer/wintermonths, etc.All of these questions ensure that there is no “culturalmisalignment of services.” This occurs when a specificcommunity does not value the services provided andthere<strong>for</strong>e does not use them.For example, if a particular community valuesadult children as the primary caregivers <strong>for</strong> elderparents, sending a home health aide (a stranger)to care <strong>for</strong> an elder parent creates a cultural misalignmentof services. Training and supportingadult children to better care <strong>for</strong> their parent alignswith the values of this particular community.Include the perspective of the community whendesigning outreach materials and services. Youragency can use focus groups and consumeradvisory boards to test the effectiveness ofoutreach materials.2 6U . S . A D M I N I S T R A T I O N O N A G I N G

D E S I G N I N G S E R V I C E S( C O N T I N U E D )Where should services be delivered?At trusted community providers, through churches andsocial groups, in the home, etc.What are the structural and cultural barriers to services?• Family role: grandparent, caregiver, etc.• Income• Transportation• Health status/condition• Cultural/group values• Health literacy/language• Geography/rural environment• Access <strong>for</strong> individuals with disabilities• Environmental conditions/home settingThink about non-traditional locations <strong>for</strong>providing services to better target your outreach.Understanding barriers in the community cansave valuable time and money and help shiftresources to where they are most needed ina community.A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 2 7

S T E P 3 : D E S I G N I N G S E R V I C E SD i v e r s e C o m m u n i t yQ u e s t i o n n a i r eThe <strong>Diverse</strong> Community Questionnaire is a tool that allows your agency, its partners, and stakeholders to have aconversation about what respectful, inclusive, and sensitive services are to a particular community. We encourageyour agency to use this tool with flexibility, and tailor this questionnaire to meet the particular needs of thecommunities it serves.Target Population:________________________________________________________________________________________What is the service population’sneighborhood/community location?Designing services that are respectful, inclusive,and sensitive is the hallmark of quality servicedelivery. The questions below assist your agencywith defining what quality service means to aparticular community based on its characteristics,which were explored in Step 2.________________________________________________________________________________________2 8U . S . A D M I N I S T R A T I O N O N A G I N G

Based on the data your agency has collected aboutthis service population, its community, and trustedorganizations (e.g., churches, social clubs, grassrootsnonprofit social services):How should outreach and marketing materialsbe improved or implemented to better serve thispopulation?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Do marketing/outreach materials show pictures ofindividuals from the community ? Yes NoAre marketing/outreach materials languageappropriate/bilingual?Yes NoOther marketing/outreach strategies:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Do marketing/outreach materials discuss publicaccessibility of services (e.g., building accessibility andwhich bus line, subway stop, transportation companiesprovide access to the service area)?Yes NoIf no, what steps does your agency plan totake to in<strong>for</strong>m the service population of serviceaccessibility?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________How will marketing/outreach materials be pilottested/reviewed, and by whom in the community(e.g., focus groups, interviews, surveys, consumeradvisory board)?_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Do marketing/outreach materials indicate theavailability of bilingual staff, including sign languageinterpreter(s)? Yes NoA T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 2 9

Which group in this population’s community wouldbenefit most from your agency’s services (e.g., clients,caregivers, community organizations)?_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Which services does your agency provide that wouldbe the most valuable to this population?_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________How and where should services be delivered (e.g.,with the assistance of family/life partners or caregivers,through a visible and trusted partnering agency in thecommunity, in the home)?_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Which legal requirements (e.g., anti-discriminationlaws, population targeting requirements, translationrequirements) regarding service accessibility apply toservices you provide to this population?_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Which steps does your agency plan to take to ensurethat its policies, procedures, and services are alignedwith legal requirements regarding service accessibility<strong>for</strong> this group (e.g., anti-discrimination laws, servicepopulation targeting requirements)?_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What are the structural barriers* that limit services<strong>for</strong> this group (e.g., transportation, childcare <strong>for</strong>grandchildren, health literacy/education, income)?____________________________________________________________________________________________________________________________________________________________* Defined in Appendix B: Definitions3 0U . S . A D M I N I S T R A T I O N O N A G I N G

Which steps does your agency plan to take to reduceor eliminate structural barriers to services <strong>for</strong> thispopulation?_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What are the cultural barriers* that limit servicesto this group (e.g., stigma of accepting help, valuesconcerning gender/family roles, religious/spiritualbeliefs)?_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Which steps does your agency plan to take to reduceor eliminate cultural barriers* to services <strong>for</strong> thispopulation?___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Additional Notes:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________* Defined in Appendix B: DefinitionsA T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 3 1

S T E P 4 : P R O G R A ME V A L U A T I O NI n t r o d u c t i o nPurposeThe purpose of this step is to promote discussion onthe significance of program evaluation.SummaryThis section explains Step 4 by providing briefquestions, answers, and discussion points. Thisin<strong>for</strong>mation helps your agency consider which programevaluation methods and tools will best assess youragency’s effectiveness and client satisfaction.It is important to evaluate the quality, delivery, andper<strong>for</strong>mance of your program—from both yourviewpoint and client and community perspectives.Core Learning QuestionWhat types of program evaluation methods are bestsuited to measure program effectiveness and client andcommunity satisfaction?Supplemental <strong>Toolkit</strong> Resources <strong>for</strong> Step 1For resources and guidance on program evaluation, see:Appendix G: List of Online Resources <strong>for</strong> Step 43 2U . S . A D M I N I S T R A T I O N O N A G I N G

P R E S E N T A T I O N : T H E S T E P S O F P L A N N I N GS E R V I C E S F O R D I V E R S E C O M M U N I T I E SS T E P 1 : AssessmentsS T E P 2 : Identifying ResourcesAbout the Community• Organization and client evaluationof servicesS T E P 3 : Designing Services• Lessons learnedS T E P 4 : Program EvaluationProgram evaluation data helps your agency make the case that it is being true to its commitment and mission to serveall older adults.A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 3 3

O R G A N I Z A T I O N A L A N D C L I E N TE V A L U A T I O N O F S E R V I C E SWhat should be evaluated?Services (provided by both the agency and its partners);client and community perceptions of the quality andeffectiveness of services.Why?Evaluates the process of service delivery and thequality of services.How?Process evaluation.The value of measuring both delivery andquality helps your agency evaluate whether itsperceptions of its services are aligned with theperceptions of diverse clients and communities.Outcome evaluation.Value?Ensures that program process and outcomes align withthe values and needs of the client and community.P R O C E S S E V A L U A T I O NWhat?Evaluates the way a program is implemented and howeffectively it is being managed.Depends on . . .How well program components and activities aredefined and identified.Asks . . .“How does our agency manage the program to getthings done?” and “Are we managing the program inthe most effective way?” (continued on next page)By appreciating how a program is implementedand managed, your agency can understandits program components and the way thosecomponents are being delivered and meetingdiverse client and community needs.3 4U . S . A D M I N I S T R A T I O N O N A G I N G

(continued from last page)Value?Helps to identify:If the program is operating in the most effective way.The program’s strengths and weakness.Program components that need to be added, changed,or eliminated.O U T C O M E E V A L U A T I O NWhat?Determines the program’s effectiveness <strong>for</strong> its intendedclient and whether goals were met and desired outcomeswere accomplished.Depends on . . .How clearly program goals and objectives are defined.Asks . . .“What were the program’s results?” and “Did we meetour goal?”Value?Helps to identify:Outcome evaluation allows your agency to gobeyond output (counting the number of timesan activity occurs) and begin to move towardmeasuring results and service quality.Outcome evaluation should include bothqualitative (descriptive) and quantitative(numeric) data. Each can reveal somethingvaluable about the service population.If the program is meeting its intended goalsand objectives.If services are meeting client expectations and reflectcommunity values.Unanticipated outcomes and/or effects that can bepositive or negative.A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 3 5

D A T AWhat?Data is in<strong>for</strong>mation that comes in two <strong>for</strong>ms:Quantitative – in the <strong>for</strong>m of numbers (statisticalin<strong>for</strong>mation)Qualitative – in the <strong>for</strong>m of words (descriptivein<strong>for</strong>mation)Data sources are all around usCase management database, records and files, existingstatistics, and input from clients and partners.How do I collect the data?• Documenting and tracking activities• Database queries• Questionnaires and surveys• Interviews• Observation• Focus groupsIt’s important that primary source data (datafrom the original source—the client) iscompared to secondary source data (sourcesother than the client).Comparing both data sources allows youragency to see inconsistencies in results. Askingclients to clarify any inconsistencies in thedata can further support a robust analysis ofevaluation data.H O W D O E S Y O U R A G E N C Y S T A R T ?1. Develop a model or description of your program.Clarify program goals and objectives.Clearly identify program components and activities.2. Determine what type of evaluation (process and/oroutcomes) is needed.3. Choose the type of data collection method.Your agency should think about cost and capacity:• Does your agency include evaluation as aregular part of a program’s budget?• Does your agency have supports and systemsin place to manage evaluation easily?4. Choose the data source(s).5. Select an evaluation team and define specific rolesand tasks.3 6U . S . A D M I N I S T R A T I O N O N A G I N G

Identify partners and agencies whose expertise youragency can leverage.Don’t <strong>for</strong>get to include client and communityrepresentation.6. Make sure evaluation questions are aligned with:The program goals, objectives, and/or outcomes youare measuring.The program’s components and activities.The clients’ and community’s identified needs,expectations, and values.7. Create data collection protocols and review datacollection capacity.Develop a guidance document <strong>for</strong> consistentdata collection (i.e., everyone is collecting the same typeof data and that data is clearly defined).Good questions are at the core of a solidevaluation. Make sure your questions are alignedwith specific program components, activities,goals, and results (which shouldhave been defined at the beginning of yourevaluation plan).A good evaluation process is characterizedby support.• Does your evaluation team have agreed-uponguidelines to support the staff involved in thedata collection process?• Does your evaluation team have access tosystems that make it easy to capture andcollect data?Check telephonic and case management system’sability to capture the type and quality of data needed.L E S S O N S L E A R N E DWho?Everyone involved in the process, including thecommunity.Why?Helps an agency identify how to make programs better<strong>for</strong> a particular diverse community.Value?Demonstrates that an agency is invested not onlyin its programs, but the community it serves.Your agency can use evaluation data to educatestaff, advisory and other boards, partners,volunteers, and the service community on how toimprove services—it’s a collaborative process.When clients and their community are involvedin program evaluation, it gives any agency theopportunity to empower stakeholders to sharethe responsibility <strong>for</strong> improving services.Strengthens the community’s role as a stakeholder.A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 3 7

S T E P 4 : P R O G R A M E V A L U A T I O ND i v e r s e C o m m u n i t yQ u e s t i o n n a i r eThe <strong>Diverse</strong> Community Questionnaire is a tool that allows your agency, its partners, and stakeholders to have aconversation about what respectful, inclusive, and sensitive services are to a particular community. We encourageyour agency to use this tool with flexibility, and tailor this questionnaire to meet the particular needs of thecommunities it serves.Target Population:________________________________________________________________________________________What is the service population’sneighborhood/community location?Program evaluation helps your agency make thecase that it is being true to its commitment andmission to provide quality service to all olderadults. The questions to follow allow your agencyto consider how program evaluation can help itimprove its services.________________________________________________________________________________________3 8U . S . A D M I N I S T R A T I O N O N A G I N G

Is a program evaluation approach established <strong>for</strong> theservices this community needs and values the most?Yes NoIf yes, which resources has your agency identified thatcan help with evaluating services <strong>for</strong> this community?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________If no, how does your agency plan to evaluate thoseservices?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Which partners or potential partners can help youragency evaluate services <strong>for</strong> this community?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What is your agency’s plan <strong>for</strong> verifying evaluationresults with partner, client, and communityperceptions of your agency’s services (e.g., focusgroups, interviews, surveys, questionnaires)?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Does your agency know the data collection barriers<strong>for</strong> this community (e.g., trust, confidentiality, previousnegative experiences with research)?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What type of data collection methods align withthe communication traditions of this community(oral tradition, written tradition, or both)? Shouldthere be any special considerations made based oncommunication traditions?________________________________________________________________________________________________________________________________________________________________________________________________________________A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 3 9

Does your agency plan to collect quantitative(numeric) data, qualitative (descriptive) data, or both?Why or why not, and what does your agency think isbest <strong>for</strong> this community?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Does your agency plan to use both output (countingthe number of times or occurrences of an activity), aswell as outcome (results) measures? Yes NoIf no, how does your agency plan to measure data?Which data measurement methods will it include?____________________________________________________________________________________________________________________________________________________________How does your agency plan to use the data to improveservices <strong>for</strong> this community? What is the data’s valueto your agency, its partners, and the community?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________How does your agency plan to share or disseminate itsevaluation data and lessons learned to empower thecommunity to engage in better self-advocacy?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________4 0U . S . A D M I N I S T R A T I O N O N A G I N G

A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 4 1

A T o o l k i t f o r S e r v i n gD i v e r s e C o m m u n i t i e sA p p e n d i c e sP a r t T w o

D I V E R S E C O M M U N I T YQ U E S T I O N N A I R EA p p e n d i x AThe <strong>Diverse</strong> Community Questionnaire is a tool thatallows your agency, its partners, and stakeholders tohave a conversation about what respectful, inclusive,and sensitive services are to a particular community.We encourage your agency to use this tool withflexibility, and tailor this questionnaire to meet theparticular needs of the communities it serves.Target Population:________________________________________________________________________________________What is the service population’sneighborhood/community location?________________________________________________________________________________________4 2U . S . A D M I N I S T R A T I O N O N A G I N G

S T E P 1 : A S S E S S M E N T SOrganizational, staff, and self-assessments allow anagency to understand its collective experience andknowledge about a particular community. Whetheryour agency wants to improve its services <strong>for</strong> a specificgroup or wants to establish a visible and trustedpresence in a neighborhood, the questions below helpyour agency understand how assessments providea comprehensive snapshot of your ability to provideservices <strong>for</strong> that community.Has your agency provided services to this community?Yes NoIf yes, did your agency include this community’sperspectives in its planning of program missionstatements, policies, and procedures?If no, what steps does your agency plan to take toinclude this community in its planning of programmission statements, policies, and procedures (e.g.,consumer advisory boards, community advisorycouncils, advocacy groups)?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________If your agency has served or currently serves thiscommunity, what did it learn about the communitythat could be helpful in providing better services?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________If your agency has served or currently serves thiscommunity, what feedback has it received about thiscommunity’s perspectives of your services?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 4 3

How can your agency improve or enhance thisperspective?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Are any of your agency’s staff, board members,committee members, and/or consumer advisory-boardmembers from this community?Yes NoIf yes, what knowledge and skills do they have that canhelp your agency better serve this population?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________If no, what steps does your agency plan to take toprovide representation from this community whileoffering services to its older adult population?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Have any of your staff had experience serving thispopulation, either with your agency or with otheragencies? Yes NoIf yes, what knowledge and skills did they gain to helpyour agency provide better services to this population(e.g., bilingual skills, established relationships withtrusted community organizations, knowledge ofneighborhood advisory board members)?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________How do individual staff members characterize thiscommunity (e.g., difficult to serve, in<strong>for</strong>mal caregivingnetwork)?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________4 4U . S . A D M I N I S T R A T I O N O N A G I N G

What is this characterization based on (e.g., data,feedback from individuals outside of the population’scommunity, feedback from individuals within thepopulation’s community, service providers, staffobservation)?_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________S T E P 2 : I D E N T I F Y I N GR E S O U R C E S A B O U T T H EC O M M U N I T YKnowing where to find accurate in<strong>for</strong>mation about aservice community is invaluable when planning servicedelivery. The questions in Step 2 assist your agencywith identifying resources (such as data, research,and studies) that help it understand the characteristicsof the service population (such as family structure,community resources, and health disparities).Understanding the characteristics of a servicepopulation prepares your agency <strong>for</strong> Step 3,Designing Services.Which resources does your agency’s staff use to obtaincurrent in<strong>for</strong>mation and training on providing servicesto this population?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Has your agency offered staff opportunities to learnabout this particular population? Yes NoIf yes, please describe how these learning opportunitiescan help your agency provide better services to thispopulation.________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Can staff identify additional training or technicalassistance that would be helpful in serving thispopulation?_______________________________________________________________________________________________________________________________________________________________________________________________________________________________A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 4 5

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________Which organizations, including current partners,can assist your agency and staff with learning howbest to serve this population? (As you think aboutthese organizations, consider whether or not they areorganizations that are visible, respected, and trusted bythe community your agency serves.)_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What do national, state, and local data reveal aboutthe needs of this community (e.g., education, income,living arrangements)?U.S. Census Bureau: www.census.govAoA Aging Statistics: www.aoa.gov/AoARoot/Aging_Statistics/index.aspx_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What do disease and illness (morbidity) data revealabout the needs of this population?AoA statistics: www.aoa.gov/AoARoot/Aging_Statistics/index.aspxAHRQ National Healthcare Quality & DisparitiesReports: www.ahrq.gov/qual/qrdr08.htmCDC National Health Statistics home page:www.cdc.gov/nchs______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Based on state and community level data andcommunity partners, how would your agencycharacterize the following? These answers mightchange as your agency gets more in<strong>for</strong>mationfrom partners and verifies this in<strong>for</strong>mation with thecommunity.a. Community-based supports(e.g., family, church, grassroots organizations)Good Fair Poorb. Social service resourcesGood Fair Poorc. Environmental conditions(e.g., pollution/air quality)Good Fair Poor4 6U . S . A D M I N I S T R A T I O N O N A G I N G

d. Public transportationGood Fair Poore. Economic stabilityGood Fair Poorf. Opportunities <strong>for</strong> community involvement(e.g., socialization, volunteerism, clubs)Good Fair PoorHow does this in<strong>for</strong>mation (a – f) influence the typesof services your agency provides <strong>for</strong> this population?_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Community’s most common family structure:Nuclear Extended Other:____________________________________________________What are this community’s religious/spiritual beliefsand practices?__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________How will these religious/spiritual beliefs and practicesinfluence the services your agency provides?_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________These answers might change as your agency gets morein<strong>for</strong>mation from partners and verifies this in<strong>for</strong>mationwith the service population.Check all that apply:______ Decisions are made by the client.______ Decisions are made by the client and familymember(s) (adult children/spouse/partner).______ Decisions are made by the group consensusof various loved ones.______ Decisions are made by another (in the caseof homelessness, mental health issues,guardianship).______ Females are the primary caretakers in thiscommunity.______ Males are the primary caretakers in thiscommunity.______ Adult children are the primary caretakers inthis community.A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 4 7

______ Spouses/partners are the primary caretakersin this community.______ Caretakers could be any loved one and/orindividual in the community.______ Another provides primary care (in the caseof homelessness, mental health issues,guardianship).What are the primary languages (including signlanguage) of this community?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Is this population historically an immigrantcommunity? Yes NoIf yes, how will the issue of immigration influencethe types of services your agency provides (e.g., legalservices, housing, employment)?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What are your agency’s plans to ensure that clientinput is used in the planning of services and theirdelivery (e.g., focus groups, interviews, consumeradvisory boards, surveys)?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________S T E P 3 : D E S I G N I N GS E R V I C E SDesigning services that are respectful, inclusive,and sensitive is the hallmark of quality service delivery.The questions below assist your agency with definingwhat quality service means to a particular communitybased on its characteristics, which were exploredin Step 2.Based on the data your agency has collected aboutthis service population, its community, and trustedorganizations (e.g., churches, social clubs, grassrootsnonprofit social services):How should outreach and marketing materialsbe improved or implemented to better serve thispopulation?________________________________________________________________________________________________4 8U . S . A D M I N I S T R A T I O N O N A G I N G

________________________________________________________________________________________________________________________________________________________________________________________________Do marketing/outreach materials show pictures ofindividuals from the community ? Yes NoAre marketing/outreach materials languageappropriate/bilingual?Yes NoOther marketing/outreach strategies:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Do marketing/outreach materials discuss publicaccessibility of services (e.g., building accessibilityand which bus line, subway stop, senior transportationcompanies provide access to the service area)?Yes NoIf no, what steps does your agency plan totake to in<strong>for</strong>m the service population of serviceaccessibility?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________How will marketing/outreach materials be pilottested/reviewed, and by whom in the community(e.g., focus groups, interviews, surveys, consumeradvisory board)?_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Do marketing/outreach materials indicate theavailability of bilingual staff, including sign languageinterpreter(s)? Yes NoWhich group in this population’s community wouldbenefit most from your agency’s services (e.g., clients,caregivers, community organizations)?_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 4 9

Which services does your agency provide that wouldbe the most valuable to this population?_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________How and where should services be delivered (e.g.,with the assistance of family/life partners or caregivers,through a visible and trusted partnering agency in thecommunity, in the home)?_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Which legal requirements (e.g., anti-discriminationlaws, population targeting requirements, translationrequirements) regarding service accessibility apply toservices you provide to this population?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Which steps does your agency plan to take to ensurethat its policies, procedures, and services are alignedwith legal requirements regarding service accessibility<strong>for</strong> this group (e.g., anti-discrimination laws, servicepopulation targeting requirements)?_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What are the structural barriers* that limit services<strong>for</strong> this group (e.g., transportation, childcare <strong>for</strong>grandchildren, health literacy/education, income)?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Which steps does your agency plan to take to reduceor eliminate structural barriers <strong>for</strong> this population?_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________* Defined in Appendix B: Definitions5 0U . S . A D M I N I S T R A T I O N O N A G I N G

What are the cultural barriers* that limit services to thisgroup (e.g., stigma of accepting help, values concerninggender/family roles, religious/spiritual beliefs)?_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Which steps does your agency plan to take to reduceor eliminate cultural barriers* <strong>for</strong> this population?_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________S T E P 4 : P R O G R A ME V A L U A T I O NProgram evaluation helps your agency make the casethat it is being true to its commitment and mission toprovide quality service to all older adults. The questionsto follow allow your agency to consider how programevaluation can help it improve its services.Is a program evaluation approach established <strong>for</strong> theservices this community needs and values the most?Yes NoIf yes, which resources has your agency identified thatcan help with evaluating services <strong>for</strong> this community?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________If no, how does your agency plan to evaluate thoseservices?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Which partners or potential partners can help youragency evaluate services <strong>for</strong> this community?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________* Defined in Appendix B: DefinitionsA T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 5 1

What is your agency’s plan <strong>for</strong> verifying evaluationresults with partner, client, and communityperceptions of your agency’s services (e.g., focusgroups, interviews, surveys, questionnaires)?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Does your agency know the data collection barriers<strong>for</strong> this community (e.g., trust, confidentiality, previousnegative experiences with research)?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What type of data collection methods align withthe communication traditions of this community(oral tradition, written tradition, or both)? Shouldthere be any special considerations made based oncommunication traditions?________________________________________________________________________________________________________Does your agency plan to collect quantitative(numeric) data, qualitative (descriptive) data, or both?Why or why not, and what does your agency think isbest <strong>for</strong> this community?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Does your agency plan to use both output (countingthe number of times or occurrences of an activity), aswell as outcome (results) measures? Yes NoIf no, how does your agency plan to measure data?Which data measurement methods will it include?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________5 2U . S . A D M I N I S T R A T I O N O N A G I N G

How does your agency plan to use the data to improveservices <strong>for</strong> this community? What is the data’s valueto your agency, its partners, and the community?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________How does your agency plan to share or disseminate itsevaluation data and lessons learned to empower thecommunity to engage in better self-advocacy?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Additional Notes:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 5 3

D E F I N I T I O N SA p p e n d i x BThe list of definitions presented in this appendix is intended as a starting point <strong>for</strong> users of this <strong>Toolkit</strong>. Agency staffand partners are encouraged to add to this list as needed.AcculturationThe degree to which an individual adjusts, fits into, oradopts another culture as his/her own.AssimilationAdopting another cultural group’s values, beliefs,behaviors, and attitudes.Cross-Cultural CommunicationInteraction between diverse individuals or groups.CultureA group with shared values, religion, language, and/orheritage. (Culture refers to more than just race andethnicity; it also applies to groups, their members, andaffiliations.)Cultural AwarenessBeing mindful, attentive, and conscious ofsimilarities and differences between cultural groups.*Cultural BarrierA difference in cultural values and perceptions abouttreatment, care, and services that limit a person’sability to access services.Cultural BrokeringBridging, linking, or mediating between groups orpersons from different cultures to reduce conflict and/or produce change.*Cultural CompetencyThe capacity to function effectively as an individualor organization within the context of the culturalbeliefs, behaviors, and needs of consumers and theircommunities.**Cultural Misalignment of ServicesWhen services do not fit or are not valued in acommunity.* Goode, Tawara, Suganya Sockalingam, Lisa L. Snyder, Claire Dunne, and Isabella Lorenzo Hubert. 2004. The Essential Roleof Cultural Broker Programs. Washington DC: Georgetown University, National Center <strong>for</strong> Cultural Competence.5 4U . S . A D M I N I S T R A T I O N O N A G I N G

Cultural ProficiencyPolicies and practices of an organization, or valuesand behaviors of an individual, that enable the agencyor person to interact effectively in a culturally diverseenvironment. Cultural proficiency is reflected in theway an organization treats its employees, clients, andcommunity.***Cultural SensitivityUnderstanding the needs and emotions of one’s ownculture and the culture of others, and understandinghow the two may differ.*DiversityEthnic, socioeconomic, religious, and gender variety ina group, society, or institution.Ethnic GroupIndividuals who share values, traditions, and socialnorms.Intercultural DifferencesDifferences within cultures; <strong>for</strong> example, differencesbetween Vietnamese, Chinese, Korean, Japanese,Filipino populations within the Asian culture.Linguistic CompetencyThe ability of an organization to communicateeffectively and convey in<strong>for</strong>mation in a mannerthat is easily understood by diverse audiences.*Operational Knowledge of <strong>Serving</strong> <strong>Diverse</strong>PopulationsA demonstration of how to serve diverse populations.RaceA division of humankind possessing traits that aretransmissible by descent and sufficient to characterizeit as a distinctive human type.Structural BarrierTechnical or logistical factors that limit a person’sability to access services.Technical Knowledge of <strong>Serving</strong> <strong>Diverse</strong> PopulationsKnowledge of how to serve diverse populations.WorldviewThe sum of a person’s or group’s perspectivesincluding opinions, judgments, and beliefs based onculture, values, and life experiences.** U.S. Department of Health and Human Services, Office of Minority Health, http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=11*** Lindsey, Randall B., Kikanza Nuri Robins, and Raymond D Terrell. 2009. Cultural Proficiency: A Manual <strong>for</strong> School Leaders.Thousand Oaks, CA: Corwin.A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 5 5

D I V E R S I T Y C O N C E P T SA p p e n d i x CThe list of concepts presented in this appendix is intended as a starting point <strong>for</strong> users of this <strong>Toolkit</strong>. Agency staffand partners are encouraged to add to these concepts.A D D R E S S I N GG E N E R A L I Z A T I O N SWhen your agency begins to learn about servingdiverse populations, it will quickly realize that thereis a fine line between describing similar groupbehaviors and attitudes and generalizing about groupbehaviors and attitudes. So how can your agency trulyunderstand diverse communities without generalizing?Professionals who work with aging populations canauthentically understand differences without fallinginto the trap of generalizing by evaluating how diversecommunities respond to your agency’s services.* Youragency can also understand differences by validatingper<strong>for</strong>mance results with consumer advisory boards,focus groups, interviews, and survey data from clientsand their communities.Your agency will be serving diverse communitiessuccessfully when it offers services that are respectful,inclusive, and sensitive to the population it serves.Then your agency can grasp the difference betweenauthentic understanding and generalizing.C O L O R B L I N D T O R A C ESome aging agencies believe it is simply better to be“colorblind to race.” The underlying assumption inthis statement is that a person cannot possibly beprejudiced because he/she does not see race and,there<strong>for</strong>e, treats everyone the same. This position,although seemingly ideal, may not account <strong>for</strong>differences that may be at the core of defining whatis respectful, inclusive, and sensitive service delivery<strong>for</strong> a particular community. While some people maynot acknowledge racial differences, recognizing andaddressing these differences may play a key role inunderstanding how to modify services to meet theneeds of diverse communities successfully.* To learn more about program evaluating, see Part I, Step 4: Program Evaluation, and AppendixG: List of Online Resources <strong>for</strong> Step 4.5 6U . S . A D M I N I S T R A T I O N O N A G I N G

M E L T I N G P O T V S .S A L A D B O W LThe terms “melting pot” and “salad bowl” refer todifferent points of view of how people think aboutdiversity in the United States.The melting pot viewpoint asserts that diverse groupswill “melt” into the majority culture, or assimilate intothe mainstream community or group, by adopting thevalues, beliefs, behaviors, and attitudes of the majorityculture.The salad bowl viewpoint asserts that diverse groupsnever “melt” or disappear into the majority culture.Among salad bowl proponents, differences are bothunique and valued, like each ingredient in a salad.<strong>Diverse</strong> groups experience degrees of assimilation, butcultural differences (including group affiliations, suchas veterans) remain significant.A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 5 7

D I S C U S S I O N S C E N A R I O SA p p e n d i x DThe scenarios presented in this appendix are starting points <strong>for</strong> users of this <strong>Toolkit</strong>. Agency staff and partners areencouraged to create their own scenarios to share with staff and partners.C U L T U R A L B R O K E R I N GF O R A M E R I C A N I N D I A NC L I E N T SAcculturationThe degree to which an individual adjusts, fits into,or adopts another culture as his/her own.Ethnic GroupA group of individuals who share values, traditions,and social norms.Cultural BrokeringBridging, linking, or mediating between groups orpersons from different cultures to reduce conflict and/or produce change.Cultural SensitivityUnderstanding the needs and emotions of one’s ownculture and the culture of others.An American Indian elder and his daughter come tothe Area Agency on Aging (AAA) <strong>for</strong> assistance. Whenapproached by a social worker and asked if they needhelp, the adult daughter states politely, “We are looking<strong>for</strong> Cynthia Ray.” Cynthia Ray is the only American Indiansocial worker at the AAA. The social worker replies,“Cynthia is not here today, but I can help you.” The elderstates politely, “No thank you.” Then he and his daughterleave the AAA. The next week, the same client and hisdaughter return to the AAA <strong>for</strong> services. Another socialworker approaches the client and his daughter and asksthem if they need assistance. The client states politely,“No thank you.” After Cynthia Ray finishes with anotherclient, the American Indian elder and his daughterapproach Cynthia Ray <strong>for</strong> assistance. Social work staff seethis occurrence and begin to notice that American Indianclients want to be served only by Cynthia Ray. While a fewstaff do not perceive this preference as a problem, mostdo and begin to call this preference “discrimination.” Atthe next staff meeting, the AAA director knows she mustaddress this issue to ensure that respectful, inclusive, and5 8U . S . A D M I N I S T R A T I O N O N A G I N G

sensitive services are provided by her staff <strong>for</strong> AmericanIndian elders and their families.1. Does the staff’s reaction to the preferencesof American Indian elders and their familiesdemonstrate cultural sensitivity? Why orwhy not?2. How do acculturation and ethnicity influenceAmerican Indian client preferences?3. How can the AAA director use Cynthia Ray’sknowledge and gained trust to support the AAA’sservices <strong>for</strong> American Indian elders and theirfamilies? (Think about roles <strong>for</strong> cultural brokeringand staff education.)4. Consider and discuss issues of trust regardingAmerican Indian history and culture. Coulda lack of trust be mistakenly interpreted asdiscrimination? Why or why not?Supplemental MaterialsTo further explore the issue of acculturation, see:Appendix E: Companion Presentations - John W.Berry’s Model of Acculturation PresentationA C C U L T U R A T I O N : A NA S I A N F A M I L Y A N DH O M E H E A L T H A I DIntercultural DifferencesDifferences within cultures; <strong>for</strong> example, differencesbetween Vietnamese, Chinese, Korean, Japanese, andFilipino populations within the Asian culture.AcculturationThe degree to which an individual adjusts, fits into, oradopts another culture as his/her own.D E G R E E S O FA C C U L T U R A T I O N *AssimilationWhile the client welcomes and fully socializes withindividuals outside of his/her cultural group, to a lesserdegree, the client stops embracing or valuing his/herown culture and begins to embrace another culture.IntegrationThe client welcomes and fully socializes with peopleboth inside and outside of his/her cultural group.*Berry, J.W. 1997. Immigration, acculturation and adaptation. Applied Psychology: An International Review. 46:5-34.A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 5 9

SeparationThe client’s primary focus is maintaining values withinhis/her own culture rather than building relationshipswith people outside of his/her culture.MarginalizationThe client does not socialize with people outside ofhis/her cultural group; nor does he/she focus onmaintaining relationships within his/her cultural group.An Asian-American family calls the Area Agencyon Aging (AAA) to complain about a “rude” homehealth care provider. The family describes theAfrican-American home health aide as “loud” and“confrontational.” The staff of the home health agencyand AAA debate whether or not it is a cultural issuebecause the family also made the same complaintabout a Caucasian aide. In an attempt to resolve theissue, the AAA works with the home health agencystaff to determine what they believe to be a culturallyappropriate match <strong>for</strong> the client. They send a 25-yearoldAsian-American aide to the client. The complaintscontinue.1. Could acculturation be an issue? If so, how?2. How would you define the client and her family’slevel of acculturation?3. Could the African-American and Caucasianhome health aides share the same level ofacculturation?4. Regarding the 25-year-old Asian-American healthhome aide, could acculturation and interculturaldifferences be an issue as well?Supplemental MaterialsTo further explore the issue of acculturation, see:Appendix E: Companion Presentations - John W.Berry’s Model of Acculturation PresentationT H E H E A R I N G I M P A I R E DO L D E R A D U L T : A NE X P E C T A T I O N O FS E R V I C E D E L I V E R YCultural AwarenessBeing mindful, attentive, and conscious of similaritiesand differences between cultural groups.Cultural BarrierA difference in cultural values and perceptions abouttreatment, care, and services that limit a person’sability to access services.Cultural Misalignment of ServicesWhen services do not fit or are not valued in acommunity.Structural BarrierTechnical or logistical factors that limit a person’sability to access services.WorldviewThe sum of a person’s perspectives, including opinions,judgments, and beliefs based on culture, values, andlife experiences.6 0U . S . A D M I N I S T R A T I O N O N A G I N G

An older adult who has been deaf all of his life, is fluentin sign language, and reads lips, seeks services at thelocal Area Agency on Aging (AAA). While completingthe client’s assessment, the service provider learnsthe client has been a long-time consumer of services<strong>for</strong> individuals with disabilities at the Center <strong>for</strong>Independent Living. After the assessment is completed,the service provider states loudly and slowly: “Youshould consider getting a hearing aid. I think I canidentify some resources to cover that cost.” The clientshakes his head, indicating “no,” while frowning atthe aging professional. Using sign language he states,“Maybe I don’t need a hearing aid. Maybe you need tolearn sign language.”1. Do you think there is a cultural misalignment ofservices? Why or why not?2. How do the worldview of the client and theworldview of the professional vary?3. Are there any structural and/or cultural barriersto providing services <strong>for</strong> this client?4. How does cultural awareness play into thissituation?Supplemental MaterialsTo further explore the topics of barriers to service andworldview, see:Appendix E: Companion Presentations - Barriersto <strong>Serving</strong> <strong>Diverse</strong> <strong>Communities</strong>, WorldviewPresentationH O M E L E S S O L D E R A D U L T S :T H E V A L U E O F P A R T N E R SCultural BarrierA difference in cultural values and perceptions abouttreatment, care, and services that limit a person’sability to access services.Cultural SensitivityUnderstanding the needs and emotions of one’s ownculture and the culture of others.Structural BarriersTechnical or logistical factors that limit a person’s abilityto access services.In the last few years, Area Agency on Aging (AAA) staffin two regions of the state have noticed an increase inhomeless older adults in their service areas. To addressthe needs of this population, a group of AAA staff writesa proposal with components <strong>for</strong> transitional housing,housing placement and assistance, job counseling,training and placement, energy assistance, andmeals. The aging services professionals present theproposal to a community partner that serves homelessindividuals. The partnering agency tells the agingservices professionals they are missing very basic andcritical components in the proposal. One problem isthat the proposal starts with service provision at theAAAs, but the partner believes homeless older adultsneed a series of other services be<strong>for</strong>e they even walkinto an AAA and ask <strong>for</strong> assistance.A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 6 1

1. What could those “basic” and “critical”services be?2. Could there be cultural barriers, structuralbarriers, or both regarding those services?3. How can the partnering agency help theAAAs serve this community better?Supplemental MaterialsTo further explore this issue, see:Appendix E: Companion Presentations - Barriers to<strong>Serving</strong> <strong>Diverse</strong> <strong>Communities</strong> PresentationAppendix F: Companion Exercises - Structural orCultural BarrierP R E V I O U S L YI N C A R C E R A T E D O L D E RA D U L T S : B A R R I E R S T OS E R V I C ECultural BarrierA difference in cultural values and perceptions abouttreatment, care, and services that limit a person’sability to access services.Structural BarrierTechnical or logistical factors that limit a person’sability to access services.WorldviewThe sum of a person’s or group’s perspectives,including opinions, judgments, and beliefs based onculture, values, and life experiences.6 2U . S . A D M I N I S T R A T I O N O N A G I N G

Two Area Agency on Aging (AAA) directors havea routine phone conversation about a regionalconference. At the end of the conversation, eachmentions an increase in previously incarcerated olderadult men seeking services at their AAAs. Both agreethat “something” needs to be done to address thispopulation because trends in data indicate increasesin longer sentencing. Longer sentences lead to therelease of older adults into the community who mayneed home- and community-based services in additionto transitional services tailored to meet their specificcircumstances. Both directors feel a sense of urgencyas they discuss how their staff shared resources withthese clients, but knew that the AAA “fell short” ofmeeting these clients’ needs.1. What could be some of the cultural barriers toproviding services <strong>for</strong> this population?2. What could be some of the structural barriers toproviding services <strong>for</strong> this population?3. With regard to opinions, judgments, and beliefs(worldviews) about serving this population, whatcould be some of the barriers these directorscould encounter with AAA staff?T H E O L D E R A D U L TL E S B I A N C L I E N T :C U L T U R A L A W A R E N E S SCultural AwarenessBeing mindful, attentive, and conscious of similaritiesand differences between cultural groups.Cultural BarrierA difference in cultural values and perceptions abouttreatment, care, and services that limit a person’sability to access services.Cultural SensitivityUnderstanding the needs and emotions of one’s ownculture and the culture of others.Operational Knowledge of <strong>Serving</strong> <strong>Diverse</strong> PopulationsA demonstration of how to serve diverse populations.Technical Knowledge of <strong>Serving</strong> <strong>Diverse</strong> PopulationsKnowledge of how to serve diverse populations.An aging services professional enters a female client’sdemographic in<strong>for</strong>mation into a database to receivehospice care <strong>for</strong> cancer. The client tells the professionalthat her doctors have diagnosed her with terminalcancer. The professional asks the client, “Who wouldyou like us to contact in case of an emergency?” Theclient responds while placing her hand over the hand ofthe woman beside her, “My partner Lynn is the personI trust. We’ve been together <strong>for</strong> 12 years now. She’sthe person I want you to consult. We make decisionstogether.” Lynn then provides the professional with herfull name. When the professional asks the client aboutLynn’s relationship to her, the client states, “I just toldyou. She’s my partner. We live together.” The agingservices professional says to the client, “I need thename of a family member.” The client states, “Lynn ismy spouse.”A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 6 3

Did the aging services professional’s cultural awarenessmeet the expectations of the client? Why or why not?1. Based on the professional’s response, could acultural barrier to service occur?2. Did the professional demonstrate technicalknowledge or operational knowledge? Why orwhy not?3. How can partnering with a trusted LGBTcommunity organization assist this Area Agencyon Aging?Supplemental MaterialsTo further explore the issue of worldview and barriers toservices, see:Appendix E: Companion Presentations - WorldviewPresentationD I F F E R E N T W O R L D V I E W SO F L E A D E R S H I PCross-Cultural CommunicationInteraction between diverse individuals or groups.CultureA group with shared values, religion, language, and/or heritage. (Culture refers to more than just race andethnicity; it also applies to groups, their members,and affiliations.)Cultural AwarenessBeing mindful, attentive, and conscious of similaritiesand differences between cultural groups.Cultural BrokeringBridging, linking, or mediating between groups orpersons from different cultures to reduce conflict and/or produce change.Cultural SensitivityUnderstanding the needs and emotions of one’s ownculture and the culture of others.WorldviewThe sum of a person’s or group’s perspectives,including opinions, judgments, and beliefs based onvalues and life experiences.A group of professionals from the Aging Network attenda meeting with HIV/AIDS advocates to begin planningan older adult HIV/AIDS advocacy organization. Eachgroup recognizes an increase in the rate of HIV/AIDSinfection among community residents aged 55 andolder. In anticipation of the need <strong>for</strong> social serviceresources and advocacy <strong>for</strong> older adults living withHIV/AIDS, each group recognizes the significance ofcreating such an organization. During the meeting,each group discovers the other has a different vision ofleadership.Both groups want an older adult to lead the advocacyorganization. However, the HIV/AIDS advocates want anolder adult who is living with HIV/AIDS to take a veryvisible and active leadership role in the organization.6 4U . S . A D M I N I S T R A T I O N O N A G I N G

They argue that this individual will bring a uniqueperspective to understanding what it means to live withHIV/AIDS. They state in the meeting: “Aging Networkstaff just don’t have that kind of knowledge.” The AgingNetwork staff respond, “An individual doesn’t have tohave HIV/AIDS to represent those who are infected bythe virus.” The aging services providers add that peoplewith HIV/AIDS can be represented on the consumeradvocacy board. “That’s what those boards are <strong>for</strong>,”they state. The HIV/AIDS advocates respond, “Thatsimply isn’t good enough.” Both groups leave themeeting frustrated.7. Could this example be applied to the AgingNetwork establishing relationships with theDisability Network? If so, what could be someof the worldview implications of starting apartnership with groups representing these olderadult populations?Supplemental MaterialsTo further explore the issue of worldview, see:Appendix E: Companion Presentations -Worldview Presentation1. What may be some of the opinions, judgments,beliefs, and/or values each group has aboutleadership (worldview) that are stated or implied?2. Which worldview of consumer advocacy isrespected and by whom?3. Is each group demonstrating cultural awareness?Why or why not?4. Is each group demonstrating skills in crossculturalcommunication? Why or why not?5. Is each group demonstrating skills in culturalsensitivity? Why or why not?6. How could a cultural broker assist these groups?A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 6 5

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The presentations presented in this appendix represent a starting point <strong>for</strong> users of this <strong>Toolkit</strong>. Agency staff andpartners are encouraged to create and share their own presentations.A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 6 7

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C O M P A N I O N E X E R C I S E SA p p e n d i x FThe exercises presented in this appendix represent a starting point <strong>for</strong> users of this <strong>Toolkit</strong>. Agency staff andpartners are encouraged to create their own exercises.E X E R C I S E 1 : D E F I N I T I O N M A T C H I N GRaceEthnic GroupCultureDiversityCultural CompetencyCultural ProficiencyA group with shared values, religion, language, and/or heritage.The capacity to function effectively as an individual ororganization within the context of the cultural beliefs,behaviors, and needs of consumers and their communities.Policies and practices of an organization, or values andbehaviors of an individual, that enable the agency or personto interact effectively in a culturally diverse environment.Ethnic, socioeconomic, religious, and gender variety in agroup, society, or institution.Individuals who share values, traditions, and social norms.A division of humankind possessing traits that aretransmissible by descent and sufficient to characterize it as adistinctive human type.Answers to definitions are provided in Appendix B.1 0 4U . S . A D M I N I S T R A T I O N O N A G I N G

E X E R C I S E 2 : C U L T U R A L B A R R I E R O RS T R U C T U R A L B A R R I E R1. An agency that lacks wheelchair accessibility.C U L T U R A L B A R R I E RA difference in cultural values and perceptionsabout treatment, care, and services that limit aperson’s ability to access services.S T R U C T U R A L B A R R I E RTechnical or logistical factors that limit aperson’s ability to access services.Which of the issues below are examples of structuralor cultural barriers? Why or why not?Is it possible the issues could result in both structuraland cultural barriers?Regarding each of the situations, how do an agency’scultural (institutional) values influence barriers?Cultural or StructuralInfluence:_____________________________________________________________________________________________________________________________________________________________2. A client delaying a decision to sign up <strong>for</strong> neededservices because his/her partner is not availableto participate in the decisionmaking process.Cultural or StructuralInfluence:_____________________________________________________________________________________________________________________________________________________________A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 105

3. A client living by a bus route that suspendsservices during non-rush hours.Cultural or StructuralInfluence:_____________________________________________________________________________________________________________________________________________________________4. A client requesting a sign-language interpreter.Cultural or StructuralInfluence:_____________________________________________________________________________________________________________________________________________________________5. An agency distributing the same outreachbrochures to different diverse communities.Cultural or StructuralInfluence:_____________________________________________________________________________________________________________________________________________________________6. An agency unaware of community-based partnersproviding services to the same diverse communitygroup <strong>for</strong> which it is also providing services.Cultural or StructuralInfluence:_____________________________________________________________________________________________________________________________________________________________7. An agency serving communities that have noadvisory or consumer board representation.Cultural or StructuralInfluence:_____________________________________________________________________________________________________________________________________________________________8. An agency making the decision to collect onlyquantitative (statistical/numeric) client data.Cultural or StructuralInfluence:_____________________________________________________________________________________________________________________________________________________________9. An agency creating a policy option <strong>for</strong> boardmembers to complete self-assessments.Cultural or StructuralInfluence:_____________________________________________________________________________________________________________________________________________________________1 0 6U . S . A D M I N I S T R A T I O N O N A G I N G

E X E R C I S E 3 : T E C H N I C A LO R O P E R A T I O N A LK N O W L E D G E ?While the goal of this exercise is to identify each statement asan example of technical knowledge, operational knowledge,or both, the purpose of this exercise is to stimulate discussionamong agency staff and partners about the differences betweentechnical and operational knowledge. There<strong>for</strong>e, no prescriptiveanswer is provided. Learning is encouraged throughdiscussion based on knowledge, background, and experiences.Technical knowledge is understanding how to servediverse populations: “I can tell you.”Operational knowledge is demonstrating how to servediverse populations: “I can show you.”TechnicalOperationalTechnicalOperationalTechnicalOperational1. Staff acquire first-level trainingin cultural competency.2. Staff utilize a nutritionalassessment that asks elderlyJewish clients if their non-Jewishcaretakers need experiencewith cooking Kosher foods andmaintaining a Kosher kitchen.3. An agency completes anorganizational culturalcompetency assessment.TechnicalOperationalTechnicalOperationalTechnicalOperationalTechnicalOperationalTechnicalOperational5. A program manager changes thevision statement of a programtargeted to an American Indiancaregiving service to reflect thecultural values of that community.6. An agency invites American Indianelders and their families to assistwith creating the vision statementand its family caregiving service toreflect the cultural values of thatcommunity.7. An agency provides staff withguidance <strong>for</strong> supporting immigrantfamilies caring <strong>for</strong> family memberswith Alzheimer’s disease.8. An agency creates an intergenerationalveteran support programthat includes older adult veteransthat mentor younger, recentlydischarged veterans.9. Staff pass out health care brochuresfrom a partnering clinicadvertising free health careservices <strong>for</strong> migrant workerfamilies.TechnicalOperational4. An agency completes an organizationalcultural competencyassessment and uses the resultsto implement and enhancepolicies.TechnicalOperational10. A state’s Aging Network partnerswith local non-denominationalreligious organizations to addressincreasing numbers of older adultswith HIV/AIDS.A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 107

L I S T O F O N L I N E R E S O U R C E SA p p e n d i x GThe list of resources presented in this appendix represents a starting point <strong>for</strong> users of this <strong>Toolkit</strong>. Agency staffand partners are encouraged to add to this list of resources.S T E P 1 : A S S E S S M E N T R E S O U R C E SOrganizational and staff assessmentsA Guide to Planning and Implementing Cultural Competence Organizational Self-AssessmentNational Center <strong>for</strong> Cultural Competence, Georgetown Universityhttp://www11.georgetown.edu/research/gucchd/nccc/documents/ncccorgselfassess.pdfA Guide <strong>for</strong> Using the Cultural and Linguistic Competence Policy Assessment InstrumentNational Center <strong>for</strong> Cultural Competence, Georgetown Universityhttp://www.clcpa.info/documents/CLCPA_guide.pdfChecklist to Facilitate the Development of Culturally and Linguistically Competent Primary HealthCare Policies and Structures: Rationale <strong>for</strong> Cultural Competence in Primary Health CareNational Center <strong>for</strong> Cultural Competence, Georgetown Universityhttp://www11.georgetown.edu/research/gucchd/nccc/documents/Policy%20Brief%201%20Checklist.pdfChecklist to Facilitate the Development of Linguistic Competence within Primary Health Care Organizations:Linguistic Competence in Primary Health Care Delivery Systems Implications <strong>for</strong> Policy MakersNational Center <strong>for</strong> Cultural Competence, Georgetown Universityhttp://www11.georgetown.edu/research/gucchd/nccc/documents/Policy%20Brief%202%20Checklist.pdfCultural and Linguistic Competence Policy AssessmentNational Center <strong>for</strong> Cultural Competence, Georgetown Universityhttp://www.clcpa.info/documents/CLCPA.pdfCultural Competency Organizational Self-AssessmentAIDS Education Training Centers, National Resource Centershttp://www.aidsetc.org/doc/workgroups/cc-question-bank.docDiversity and The Aging Network: An Assessment HandbookNational Aging Resource Center: Long-Term Care, Brandeis Universityhttp://www.alz.org/national/documents/GEN_ASSESS-LTCDiversityHandbook.pdfNote: Disclaimer from the U.S. <strong>Administration</strong> on Aging (AoA)In<strong>for</strong>mation presented in this document does not constitute an endorsement or recommendation by the U.S. <strong>Administration</strong> on Aging or any ofits employees. The AoA is not responsible <strong>for</strong> the contents of any referenced Web page(s) and does not endorse any specific product or serviceprovided by public or private organizations. The user takes full responsibility <strong>for</strong> accessing any of the referenced links.1 0 8U . S . A D M I N I S T R A T I O N O N A G I N G

Assessment of Organizational Cultural CompetenceAssociation of University Centers on Disabilities (AUCD) Multicultural Councilhttp://www.aucd.org/docs/councils/mcc/cultural_competency_assmt2004.pdfSelf-assessmentsSelf-Assessment of Cultural CompetenceAssociation of University Centers on Disabilities (AUCD) Multicultural Councilhttp://www.acphd.org/AXBYCZ/Admin/Publications/ddc_self_assess_cultural_competence.docCultural Competence Self-Assessment Questionnaire: A Manual <strong>for</strong> UsersPortland Universityhttp://www.rtc.pdx.edu/PDF/pbCultCompSelfAssessQuest.pdfPromoting Cultural and Linguistic Competency: Self-Assessment Checklist <strong>for</strong> PersonnelProviding Primary Health Care ServicesNational Center <strong>for</strong> Cultural Competence, Georgetown Universityhttp://www11.georgetown.edu/research/gucchd/nccc/documents/Checklist%20PHC.pdfRationale <strong>for</strong> Self-Assessment ChecklistNational Center <strong>for</strong> Cultural Competence, Georgetown Universityhttp://www11.georgetown.edu/research/gucchd/nccc/orgselfassess.htmlAssessment toolsThe Cross Cultural Health Care Programhttp://www.xculture.org/assesstools.phpS T E P 2 : I D E N T I F Y I N G R E S O U R C E SA B O U T T H E C O M M U N I T YAgency knowledge of service communityInclusiveness at Work: How to Build Inclusive Nonprofit OrganizationsThe Denver FoundationModule 5: In<strong>for</strong>mation Gathering, Part 1: Available FactsA T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 109

http://www.nonprofitinclusiveness.org/files/Module%205.pdfModule 7: In<strong>for</strong>mation Gathering, Part 3: Compiling Resultshttp://www.nonprofitinclusiveness.org/files/Module%207.pdfModule 14: Programs and Constituentshttp://www.nonprofitinclusiveness.org/files/Module%2014.pdfStakeholder ManagementCurtin University of Technology, School of Architecture Construction and Planninghttp://www.e-campus21.com/courseware/notes/CourseMaterials/CME/PM442/PM442/topic8.pdfPartnerships and coalition buildingBridging the Cultural Divide in Health Care Settings: The Essential Role of Cultural Broker ProgramsThe National Center <strong>for</strong> Cultural Competence at the Georgetown Universityhttp://www11.georgetown.edu/research/gucchd/nccc/resources/brokering.htmlDeveloping Effective Coalitions: An Eight Step GuideThe Prevention Institutehttp://www.preventioninstitute.org/pdf/eightstep.pdfImproving Stakeholder Collaboration: A Special Report on Community-Based Health Ef<strong>for</strong>tsGroup Health Community Foundationhttp://www.cche.org/pubs/ghcf-publication-stakeholder-collaboration.pdfInclusiveness at Work: How to Build Inclusive Nonprofit OrganizationsThe Denver Foundationhttp://www.nonprofitinclusiveness.org/inclusiveness-work-how-build-inclusive-nonprofit-organizationsTen Myths that Prevent Collaboration Across CulturesAwesome Library, Evaluation and Development Institutehttp://www.awesomelibrary.org/multiculturaltoolkit-myths.htmlClient and community dataAging StatisticsU.S. <strong>Administration</strong> on Aging, U.S. Department of Health and Human Serviceshttp://www.aoa.gov/AoARoot/Aging_Statistics/index.aspxBureau of Labor StatisticsU.S. Department of Laborwww.bls.govFederal Interagency Forum on Aging Related Statisticswww.AgingStats.govInclusiveness at Work: How to Build Inclusive Nonprofit OrganizationsThe Denver Foundation (See Partnerships and Coalition Building)http://www.denverfoundation.org/File Download.cfm?file=IAW_intro.pdfMigration and Data ReportsU.S. Census Bureauhttp://www.census.gov/population/www/cen2000/migration.htmlNote: Disclaimer from the U.S. <strong>Administration</strong> on Aging (AoA)In<strong>for</strong>mation presented in this document does not constitute an endorsement or recommendation by the U.S. <strong>Administration</strong> on Aging or any ofits employees. The AoA is not responsible <strong>for</strong> the contents of any referenced Web page(s) and does not endorse any specific product or serviceprovided by public or private organizations. The user takes full responsibility <strong>for</strong> accessing any of the referenced links.1 1 0U . S . A D M I N I S T R A T I O N O N A G I N G

Minority HealthNational Institutes of Health, U.S. Department of Health and Human Serviceshttp://health.nih.gov/category/MinorityHealthNational Healthcare Disparities ReportAgency <strong>for</strong> Healthcare Research and Quality, U.S. Department of Health and Human Serviceshttp://www.ahrq.gov/qual/qrdr08.htmOffice of Minority Health, U.S. Department of Health and Human Serviceshttp://www.omhrc.gov/Office of Refugee Resettlement, <strong>Administration</strong> of Children and FamiliesU.S. Department of Health and Human Serviceshttp://www.acf.hhs.gov/programs/orr/data/05arc10appendixC.htmRacial and Ethnic Populations, Office of Minority Health and Health DisparitiesCenters <strong>for</strong> Disease Control and Prevention, U.S. Department of Health and Human Serviceshttp://www.cdc.gov/omhd/Populations/populations.htmRural and Diversity BriefingEconomic Research Service, U.S. Department of Agriculturehttp://www.ers.usda.gov/Briefing/Population/Diversity.htmSelected Long-Term Care StatisticsFamily Caregiver Alliancehttp://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=440Selected Caregiver StatisticsFamily Caregiver Alliancehttp://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=439Trends in Vision and Hearing Among Older AmericansCenters <strong>for</strong> Disease Control and Prevention, U.S. Department of Health and Human Serviceshttp://www.cdc.gov/nchs/data/ahcd/agingtrends/02vision.pdfU.S. Census Bureauhttp://www.census.gov/Women and Caregiving: Facts and FiguresFamily Caregiver Alliancehttp://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=892Client inputBasics of Conducting Focus GroupsFree Management Libraryhttp://www.managementhelp.org/grp_skll/focusgrp/focusgrp.htmEffective QuestioningFree Management Libraryhttp://www.managementhelp.org/commskls/qustning/old_qust.htmA T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 111

Inclusiveness at Work: How to Build Inclusive Non-Profit OrganizationsThe Denver FoundationModule 6: In<strong>for</strong>mation Gathering, Part 2: Stakeholder Perspectiveshttp://www.nonprofitinclusiveness.org/files/Module%206.pdfS T E P 3 : D E S I G N I N G S E R V I C E SOutreach/MarketingGetting the Word Out: Effective Health Outreach to Cultural <strong>Communities</strong>The Medtronic Foundationhttp://www.medtronic.com/downloadablefiles/outreach_brochure.pdfA Guide to Choosing and Adapting Culturally and Linguistically Competent Health Promotion MaterialsNational Center <strong>for</strong> Cultural Competence, Georgetown Universityhttp://www11.georgetown.edu/research/gucchd/nccc/documents/Materials_Guide.pdfInclusiveness at Work: How to Build Inclusive Non-Profit OrganizationsModule 15: Marketing and Community RelationsThe Denver Foundationhttp://www.nonprofitinclusiveness.org/files/Module%2015.pdfTried and True Methods <strong>for</strong> Reaching Under-Served PopulationsNational Long Term Care Ombudsman Resource Centerhttp://www.ltcombudsman.org/sites/default/files/norc/Tried-and-True-Methods.pdfService design and deliveryDeveloping Culturally-Competent Individual Service Plans <strong>for</strong> Wellness, Recovery and ResilienceNeal Adams, M.D., Cali<strong>for</strong>nia Department of Mental Healthhttp://www.afteradoption.org/Wraparound/strengthbasedserviceplans.ppt#293How Well Does Your Agency Provide Client-centered Services?Center <strong>for</strong> Health Traininghttp://www.center<strong>for</strong>healthtraining.org/documents/agency_assess.pdfMaking CLAS Happen: Six Areas <strong>for</strong> ActionA Guide to Providing Culturally and Linguistically Appropriate Services (CLAS) in a Variety of Public Health SettingsMassachusetts Department of Public Health, Office of Health Equityhttp://www.mass.gov/Eeohhs2/docs/dph/health_equity/clas_intro.docCultural CompetencyHomestead Schools, Inc. – Social WorkChapter 4 – Developing Cultural Competencehttp://www.homesteadschools.com/LCSW/courses/CulturalCompetence/Chapter04.htmlChapter 8 – Achieving Cultural Competence: A Guidebook <strong>for</strong> Providers of Services to Older Americans and Their Familieshttp://www.homesteadschools.com/LCSW/courses/CulturalCompetence/Chapter08.htmlNote: Disclaimer from the U.S. <strong>Administration</strong> on Aging (AoA)In<strong>for</strong>mation presented in this document does not constitute an endorsement or recommendation by the U.S. <strong>Administration</strong> on Aging or any ofits employees. The AoA is not responsible <strong>for</strong> the contents of any referenced Web page(s) and does not endorse any specific product or serviceprovided by public or private organizations. The user takes full responsibility <strong>for</strong> accessing any of the referenced links.1 1 2U . S . A D M I N I S T R A T I O N O N A G I N G

<strong>Serving</strong> diverse communities: challenges, barriers, and best practicesStrategy Brief: Ombudsman Program Responses to DiversityNational Association of State Units on Aginghttp://www.nasua.org/pdf/Diversity%20Dialogue.pdfChronic Disease and Pain Management – Part I PowerPoint PresentationHee Yun Yee, Ph.D., Assistant Professor, School of Social Work, University of Minnesotahttp://www.cehd.umn.edu/SSW/ContinuingEd/Documents/Module%206/Chronic%20Disease%20-%20Part%20I.pdfHealth Literacy and Cultural CompetencyChronic Disease and Pain Management Fact SheetSchool of Social Work, University of Minnesotahttp://www.cehd.umn.edu/ssw/ContinuingEd/Documents/Module%206/Reading%20guide%20-%20Module%206.pdfPromising Practices Issue Brief: Respecting DiversityReaching Out Through Local Elder Abuse NetworksNational Center on Elder Abusehttp://www.ncea.aoa.gov/ncearoot/Main_Site/pdf/PromisingPracticesRespectingDiversity.pdfSenior Nutrition Programs: Promising Practices <strong>for</strong> <strong>Diverse</strong> PopulationsNew Jersey Department of Health and Senior Serviceshttp://www.state.nj.us/health/senior/nutrition/documents/nutrition.pdfS T E P 4 : P R O G R A M E V A L U A T I O NOrganization and client evaluation of servicesBasic Guide to Program EvaluationCarter McNamara, M.B.A., Ph.D.http://208.42.83.77/evaluatn/fnl_eval.htmAn Evaluation Framework <strong>for</strong> Community Health ProgramsThe Center <strong>for</strong> Advancement of Community Based Public Healthhttp://www.cdc.gov/eval/evalcbph.pdfEverything You Wanted to Know About Logic Models but Were Afraid to AskConnie C. Schmitz and Beverly A. Parsons, InSiteshttp://www.insites.org/documents/logmod.htmEngaging New Families in EvaluationFederation of Families <strong>for</strong> Children’s Mental Healthhttp://ffcmh.org/wp-content/uploads/2009/pdffiles/Engaging%20New%20Families%20in%20Evaluation%20-%20Eng.pdfSpanish version: http://ffcmh.org/wp-content/uploads/2009/pdffiles/Engaging%20New%20Families%20in%20Evaluation%20-%20Spa.pdfA Framework <strong>for</strong> Program Evaluation: The Logic Model and Evaluation FrameworkCenter <strong>for</strong> Addiction and Mental Health, University of Torontohttp://www.problemgambling.ca/EN/ResourcesForProfessionals/Pages/AFramework<strong>for</strong>ProgramEvaluation.aspxA T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 113

How Do Measures Measure Up?Evangeline Danesco, Ph.D.The Provincial Center of Excellence <strong>for</strong> Child and Youth Mental Healthhttp://onthepoint.smartsimple.biz/files/237865/f93611/Measures_Webinar_Slides_EN.pptThe Legality of Collecting and Disclosing Patient Race and Ethnicity DataRobert Wood Johnson Foundation and The George Washington University Medical Centerhttp://www.rwjf.org/files/publications/other/RaceEthnicDisparitiesData06222006.pdfParticipatory Program Evaluation Manual: Involving Program Stakeholders in the EvaluationProcessJudi Aubel, Ph.D., M.P.H.,Child Survival Technical Support Project and Catholic Relief Serviceshttp://www.idrc.ca/uploads/user-S/10504133390Participatory_Program_Evaluation_Manual.pdfTools <strong>for</strong> Measuring Health ConditionsResource Centers <strong>for</strong> Minority Aging Research, National Institute on AgingNational Institutes of Health, U.S. Department of Health and Human Serviceshttp://www.musc.edu/dfm/RCMAR/RCMARTools.htmlToward Culturally Competent Evaluation in Health and Mental HealthThe Cali<strong>for</strong>nia Endowmenthttp://www.calendow.org/uploadedFiles/Publications/Evaluation/toward_culturally_competent_evaluation.pdfTypes of Program EvaluationCenter <strong>for</strong> Addiction and Mental Health, University of Torontohttp://www.problemgambling.ca/EN/ResourcesForProfessionals/Pages/TypesofProgramEvaluation.aspxLessons learnedEnsure Use of Evaluation Findings and Lessons Learned (tobacco cessation)Centers <strong>for</strong> Disease Control and Prevention, U.S. Department of Health and Human Serviceshttp://www.cdc.gov/tobacco/tobacco_control_programs/surveillance_evaluation/evaluation_manual/pdfs/chapter6.pdfFamily Engagement in Evaluation: Lessons LearnedFederation of Families <strong>for</strong> Children’s Mental Healthhttp://ffcmh.org/researchandpublications/FamilyEngagementinEvaluation.pdfO N L I N E R E S O U R C E S O N D I V E R S E P O P U L A T I O N SA _______________________________________________________________________________________________________________________________________________________________African-American/BlackAdaptation of an HIV Prevention Curriculum <strong>for</strong> Use With Older African American WomenJournal of the Association of Nurses in AIDS Carehttp://www.oneloveca.org/_files/_files/5245_cali<strong>for</strong>nia-CorneliusOlderAAfemHIVp08.pdfAfrican Americans and Alzheimer’s Disease: The Silent EpidemicAlzheimer’s Associationhttp://www.alz.org/Resources/Diversity/downloads/AA_EDU-SilentEpidemic.pdfNote: Disclaimer from the U.S. <strong>Administration</strong> on Aging (AoA)In<strong>for</strong>mation presented in this document does not constitute an endorsement or recommendation by the U.S. <strong>Administration</strong> on Aging or any ofits employees. The AoA is not responsible <strong>for</strong> the contents of any referenced Web page(s) and does not endorse any specific product or serviceprovided by public or private organizations. The user takes full responsibility <strong>for</strong> accessing any of the referenced links.1 1 4U . S . A D M I N I S T R A T I O N O N A G I N G

African American Health Coalitionhttp://www.aahc-portland.org/aboutUs.htmHealthy Minds. Healthy Lives.African AmericansAmerican Psychiatric Associationhttp://healthyminds.org/More-Info-For/African-Americans.aspxMental Health: A Report of the Surgeon GeneralChapter 3: Mental Health Care <strong>for</strong> African-AmericansSubstance Abuse and Mental Health Services <strong>Administration</strong>, U.S. Department of Health and Human Serviceshttp://mentalhealth.samhsa.gov/cre/ch3.aspNational Caucus and Center on Black Agedhttp://www.ncba-aged.org/African-American ProgramsAmerican Diabetes Associationhttp://www.diabetes.org/community-events/programs/african-american-programs/<strong>Serving</strong> African American Families: Home and Community Based Services <strong>for</strong> People with Dementia and Their CaregiversAlzheimer’s Associationhttp://www.aoa.gov/AoARoot/AoA_Programs/HCLTC/Alz_Grants/docs/<strong>Toolkit</strong>_4_<strong>Serving</strong>_African_Americans.pdfAmerican Indian and Alaskan NativeCenters <strong>for</strong> American Indian and Alaska Native HealthUniversity of Colorado – Denverhttp://aianp.uchsc.edu/nerc/nerc_index.htmChanging Direction: Strengthening the Shield of KnowledgeBuilding Understanding that Leads to Cross-Cultural CompetenceAIDS Education and Training Centers, National Resource Centerhttp://www.aidsetc.org/aidsetc?page=et-04-01Diabetes Program AffiliatesAssociation of American Indian Physicianshttp://www.aaip.org/?page=DAFFILIATESCultureCard: A Guide to Build Cultural Awareness, American Indian and Alaska NativeU.S. Department of Health and Human Serviceshttp://download.ncadi.samhsa.gov/ken/pdf/SMA08-4354/CultureCard_AI-AN.pdfIndian Health ServiceU.S. Department of Health and Human Serviceshttp://www.ihs.gov/Indigenous People and the Social Work Profession: Defining Culturally Competent ServicesHillary N. Weaver, School of Social Work, State University of New YorkNational Association of Social Workershttp://www.socialworkers.org/diversity/ethnic/weaver.pdfA T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 115

Mental Health: A Report of the Surgeon GeneralChapter 4: Mental Health Care <strong>for</strong> American Indians and Alaska NativesSubstance Abuse and Mental Health Services <strong>Administration</strong>, U.S. Department of Health and Human Serviceshttp://mentalhealth.samhsa.gov/cre/ch4.aspNational Indian Council on Aginghttp://www.nicoa.org/National Indian Health Boardhttp://www.nihb.org/public_health/public_health.phpNational Native American AIDS Prevention Centerhttp://www.nnaapc.org/National Resource Center <strong>for</strong> American Indian, Alaska Native and Native Hawaiian EldersUniversity of Alaska Anchoragehttp://elders.uaa.alaska.edu/about.htmNational Resource Center on Native American AgingCenter <strong>for</strong> Rural Health, University of North Dakotahttp://ruralhealth.und.edu/projects/nrcnaa/publications.phpDiabetes and Native AmericansAmerican Diabetes Associationhttp://www.diabetes.org/community-events/programs/native-american-programs/Understanding Disabilities in American Indian and Alaska Native <strong>Communities</strong>: <strong>Toolkit</strong> GuideNational Council on Disabilityhttp://www.ncd.gov/newsroom/publications/2003/native_toolkit.htmAsian American and Pacific IslanderHealthy Minds. Healthy Lives.Asian American/Pacific IslandersAmerican Psychiatric Associationhttp://healthyminds.org/More-Info-For/Asian-AmericanPacific-Islanders.aspxAssociation of Asian Pacific Community Health Organizationshttp://www.aapcho.org/site/aapcho/Asian American HealthU.S. National Library of Medicine, National Institutes of Healthhttp://asianamericanhealth.nlm.nih.gov/Mental Health: A Report of the Surgeon GeneralChapter 5: Mental Health Care <strong>for</strong> Asian Americans and Pacific IslandersSubstance Abuse and Mental Health Services <strong>Administration</strong>, U.S. Department of Health and Human Serviceshttp://mentalhealth.samhsa.gov/cre/ch5.aspNational Resource Center <strong>for</strong> Native Hawaiian EldersMyron B. Thompson School of Social Work, University of Hawaiihttp://manoa.hawaii.edu/hakupuna/publications.htmlNote: Disclaimer from the U.S. <strong>Administration</strong> on Aging (AoA)In<strong>for</strong>mation presented in this document does not constitute an endorsement or recommendation by the U.S. <strong>Administration</strong> on Aging or any ofits employees. The AoA is not responsible <strong>for</strong> the contents of any referenced Web page(s) and does not endorse any specific product or serviceprovided by public or private organizations. The user takes full responsibility <strong>for</strong> accessing any of the referenced links.1 1 6U . S . A D M I N I S T R A T I O N O N A G I N G

National Asian Pacific Center on Aginghttp://www.napca.org/National Resource Center <strong>for</strong> American Indian, Alaska Native and Native Hawaiian Elders:University of Alaska Anchoragehttp://elders.uaa.alaska.edu/about.htmReducing Health Disparities in Asian Pacific Islander PopulationsThe Providers Guide to Quality Carehttp://erc.msh.org/aapi/index.html<strong>Serving</strong> Asian and Pacific Islander Families: Home and Community-Based Services <strong>for</strong> People with Dementia and Their CaregiversAlzheimer’s Associationhttp://www.aoa.gov/AoARoot/AoA_Programs/HCLTC/Alz_Grants/docs/<strong>Toolkit</strong>_5_<strong>Serving</strong>_Asian_Pacific_Islanders.pdfC _______________________________________________________________________________________________________________________________________________________________CaregivingCultural Diversity and CaregivingFamily Caregiver Alliance, National Center on Caregivinghttp://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=1880Cultural Competence & Diversity Guidance, Resources, and Training MaterialsAging and Diversity: Module 2 – DiversityAgeWorkshttp://www.ageworks.com/course_demo/380/module2/module2.htmAmerica’s Diversity GuideNational Association of State Units on Aginghttp://www.nasua.org/issues/tech_assist_resources/national_aging_ir_support_ctr/diversity_guide/index.htmlThe Cross Cultural Health Care Programhttp://www.xculture.org/cultcompprograms.phpCulture CluesPatient and Family Education Services, University of Washington Medical Center http://depts.washington.edu/pfes/CultureClues.htmCultural Competency Learning ObjectivesHomestead Schools, Inc. – Social Workhttp://www.homesteadschools.com/LCSW/courses/CulturalCompetence/toc.htmlCultural Competency <strong>Toolkit</strong> <strong>for</strong> Broward County, FloridaThe Coordinating Council of Broward Multicultural Boardhttp://www.broward.org/celebratingdiversity/ccbculturalcomptoolkit.pdfCultural Competence Works: Using Cultural Competence to Improve the Quality of Health Care <strong>for</strong> <strong>Diverse</strong> Populations and Add Value to ManagedCare ArrangementsHealth Resources Services <strong>Administration</strong>, U.S. Department of Health and Human Servicesftp://ftp.hrsa.gov/financeMC/cultural-competence.pdfA T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 117

Cultural Complementarity ModelGreater Twin Cities United Wayhttp://www.unitedwaytwincities.org/ourimpact/culturaldynamics_complementarity.cfmCulture and Diversity Tip SheetPrevention by Designhttp://socrates.berkeley.edu/~pbd/pdfs/Culture_Diversity.pdfCultural Competence Resources <strong>for</strong> Health Care ProvidersHealth Resources Services <strong>Administration</strong>, U.S. Department of Health and Human Serviceshttp://www.hrsa.gov/culturalcompetence/Curriculula Enhancement Module SeriesNational Center <strong>for</strong> Cultural Competence, Georgetown University Center <strong>for</strong> Child and Human Developmenthttp://www.nccccurricula.info/Diversity and EquityNational Association of Social Workershttp://www.socialworkers.org/diversity/default.aspInclusiveness at Work: How to Build Inclusive Nonprofit OrganizationsThe Denver Foundationhttp://www.nonprofitinclusiveness.org/inclusiveness-work-how-build-inclusive-nonprofit-organizationsMulticultural <strong>Toolkit</strong>: <strong>Toolkit</strong> <strong>for</strong> Cross-Cultural CollaborationAwesome Library, Evaluation and Development Institutehttp://www.awesomelibrary.org/multiculturaltoolkit.htmlNational Center <strong>for</strong> Cultural Competence, Georgetown Universityhttp://www11.georgetown.edu/research/gucchd/ncccNational Standards on Culturally and Linguistically Appropriate Services (CLAS)The Office of Minority Health, U.S. Department of Health and Human Serviceshttp://www.omhrc.gov/templates/browse.aspx?lvl=2&lvlID=15Network of Multicultural Aging (NOMA)An American Society on Aging Constituent Grouphttp://www.asaging.org/networks/index.cfm?cg=NOMANew Ventures in Leadership: A Leadership Program <strong>for</strong> Professionals of Color in AgingAmerican Society on Aginghttp://www.asaging.org/nvl/index.cfmThe Office of Minority Health, U.S. Department of Health and Human Serviceshttp://minorityhealth.hhs.gov/Opening the Door to the Inclusion of Transgender People: The Nine Keys to Making Lesbian, Gay, Bisexual and Transgender Organizations FullyTransgender-InclusiveNational Gay and Lesbian Task Force Policy Institute and National Center <strong>for</strong> Transgender Equalityhttp://www.thetask<strong>for</strong>ce.org/downloads/reports/reports/opening_the_door.pdfNote: Disclaimer from the U.S. <strong>Administration</strong> on Aging (AoA)In<strong>for</strong>mation presented in this document does not constitute an endorsement or recommendation by the U.S. <strong>Administration</strong> on Aging or any ofits employees. The AoA is not responsible <strong>for</strong> the contents of any referenced Web page(s) and does not endorse any specific product or serviceprovided by public or private organizations. The user takes full responsibility <strong>for</strong> accessing any of the referenced links.1 1 8U . S . A D M I N I S T R A T I O N O N A G I N G

The Provider’s Guide to Quality & CultureManagement Sciences <strong>for</strong> Healthhttp://erc.msh.org/mainpage.cfm?file=1.0.htm&module=provider&language=EnglishRace, Ethnicity and Health CareKaiser Foundationhttp://www.kaiseredu.org/tutorials/REHealthcare/player.htmlStandards <strong>for</strong> Cultural Competence in Social Work PracticeNational Association of Social Workershttp://www.socialworkers.org/practice/standards/NASWCulturalStandards.pdfThink Cultural Health: Bridging the Health Care Gap through Cultural Competency Continuing Education ProgramsThe Office of Minority Health, U.S. Department of Health and Human Serviceshttp://www.thinkculturalhealth.org/D _______________________________________________________________________________________________________________________________________________________________Dementia/Alzheimer’s DiseaseAlzheimer’s and Dementia Caregiver Resource GuideCenter <strong>for</strong> Aging and Diversity, Institute on AgingThe University of North Carolina at Chapel Hillhttp://www.aging.unc.edu/cad/files/CaregiverResourceGuide2009.pdf10 Steps to Providing Culturally Sensitive Dementia CareThe Washington DC Area Geriatric Education Center Consortiumhttp://wagecc.gwumc.edu/pdf/10Steps.pdfDisabilityAging and Vision Loss Fact SheetThe American Federation <strong>for</strong> the Blindhttp://www.afb.org/seniorsite.asp?SectionID=68&TopicID=320&DocumentID=3374Aging with Developmental Disabilities: Position StatementTexas Council <strong>for</strong> Developmental Disabilitieshttp://www.txddc.state.tx.us/public_policy/position/aging.aspCritical Elements of an Effective Drop-In Center <strong>Serving</strong> People with Psychiatric DisabilitiesMichigan Department of Community Health and Michigan State Universityhttp://www.michigan.gov/documents/mdch/Critical_Elements_of_an_Effective_Dropin_Center_203778_7.pdfDisability EtiquetteEaster Sealshttp://www.easterseals.com/site/PageServer?pagename=ntl_etiquetteDisability Etiquette: Tips on Interacting with People with DisabilitiesUnited Spinal Associationhttp://www.unitedspinal.org/pdf/DisabilityEtiquette.pdfA T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 119

Enhancing Your Interactions with People with DisabilitiesPublic Interest Directorate of the American Psychological Associationhttp://www.apa.org/pi/disability/enhancehome.htmlGuidelines <strong>for</strong> Reporting and Writing about People with DisabilitiesResearch and Training Center on Independent LivingUniversity of Kansashttp://www.apastyle.org/manual/related/guidelines-reporting-and-writing.pdfNational Council on Disabilityhttp://www.ncd.gov/The National Council on Independent Livinghttp://www.ncil.org/Network on Environments, Services and Technologies <strong>for</strong> Maximizing Independence (NEST)An American Society on Aging Constituent Grouphttp://www.asaging.org/networks/index.cfm?cg=NESTParallels in Time I & II: A History of Developmental DisabilitiesMinnesota Governor’s Council on Disabilitieshttp://www.mncdd.org/parallels/index.htmlhttp://www.mncdd.org/parallels2/index.htmState Resource LocatorOffice on Disability, U.S. Department of Health and Human Serviceshttp://www.hhs.gov/od/topics/Resource%20Locator/resourcelocator.htmlUnderstanding Disabilities in American Indian and Alaska Native <strong>Communities</strong>: <strong>Toolkit</strong> GuideNational Council on Disabilityhttp://www.ncd.gov/newsroom/publications/2003/native_toolkit.htmVision LossFamily Caregiver Alliance, National Center of Caregivinghttp://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=2222E _______________________________________________________________________________________________________________________________________________________________English as a Second Language (ESL)Guiding Values and Principles <strong>for</strong> Language AccessNational Center <strong>for</strong> Cultural Competence, Georgetown Universityhttp://www11.georgetown.edu/research/gucchd/nccc/foundations/frameworks.html#lcprinciplesHealth Materials in Languages Other than Englishhttp://macmla.org/sdu/handouts/coughlan_non_eng.pdfLimited English ProficiencyA Federal Interagency Websitehttp://www.lep.gov/Note: Disclaimer from the U.S. <strong>Administration</strong> on Aging (AoA)In<strong>for</strong>mation presented in this document does not constitute an endorsement or recommendation by the U.S. <strong>Administration</strong> on Aging or any ofits employees. The AoA is not responsible <strong>for</strong> the contents of any referenced Web page(s) and does not endorse any specific product or serviceprovided by public or private organizations. The user takes full responsibility <strong>for</strong> accessing any of the referenced links.1 2 0U . S . A D M I N I S T R A T I O N O N A G I N G

National Council on Interpreting in Health Carewww.ncihc.orgNational Standards on Culturally and Linguistically Appropriate Services (CLAS)The Office of Minority Health, U.S. Department of Health and Human Serviceshttp://www.omhrc.gov/templates/browse.aspx?lvl=2&lvlID=15H _______________________________________________________________________________________________________________________________________________________________Health Disparities and Minority HealthCultural Competence in Health CareChronic Diseases Issue BriefCenter on an Aging Society, Georgetown Universityhttp://ihcrp.georgetown.edu/agingsociety/pdfs/cultural.pdfEstimating the Cost of Racial and Ethnic Health DisparitiesThe Urban Institutehttp://www.urban.org/uploadedpdf/411962_health_disparities.pdfIn<strong>for</strong>mation <strong>for</strong> Selected AudiencesNational Heart Lung and Blood Institute,National Institutes of Health, U.S. Department of Health and Human Serviceshttp://www.nhlbi.nih.gov/health/pubs/pub_slctpro.htm#afamDaily Health Policy ReportKaiser Health Newshttp://www.kaiserhealthnews.org/Daily-Report.aspxMaking the Grade on Women’s Health: A National and State-by-State Report CardNational Women’s Law Centerhttp://www.nwlc.org/details.cfm?id=1861&section=healthOffice of Minority and Women’s HealthNational Center <strong>for</strong> Preparedness, Detection and Control of Infectious Diseases, Centers <strong>for</strong> Disease Control and Prevention, U.S. Department ofHealth and Human Serviceshttp://www.cdc.gov/ncidod/omwh/Racial and Ethnic Disparities in U.S. Health Care: A ChartbookThe Commonwealth Fundhttp://www.commonwealthfund.org/Content/Publications/Chartbooks/2008/Mar/Racial-and-Ethnic-Disparities-in-U-S--Health-Care--A-Chartbook.aspxRural Health DisparitiesRural Assistance Center, School of Medicine and Health Science, University of North Dakotahttp://www.raconline.org/info_guides/disparities/Regional and State ActivitiesNational Partnership <strong>for</strong> Action to End Health Disparities, Office of Minority Health, U.S. Department of Health and Human Serviceshttp://minorityhealth.hhs.gov/npa/templates/browse.aspx?lvl=2&lvlid=5A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 121

State Offices of Minority and Multicultural Health Liaison MapOffice of Minority Health, U.S. Department of Health and Human Serviceshttp://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid=187U.S. Department of Health and Human Serviceshttp://www.ahrq.gov/research/minorix.htmHealth LiteracyQuick Guide to Health Literacy and Older AdultsOffice of Disease Prevention and Health Promotion, U.S. Department of Health and Human Serviceshttp://www.health.gov/communication/literacy/olderadults/literacy.htmHispanic/Latino AmericanHealthy Minds. Healthy Lives.Latinos and Mental HealthAmerican Psychiatric Associationhttp://healthyminds.org/More-Info-For/HispanicsLatinos.aspxLatino ProgramsAmerican Diabetes Associationhttp://www.diabetes.org/community-events/programs/latino-programs/Mental Health: A Report of the Surgeon GeneralChapter 6: Mental Health Care <strong>for</strong> Hispanic AmericansSubstance Abuse and Mental Health Services <strong>Administration</strong>, U.S. Department of Health and Human Serviceshttp://mentalhealth.samhsa.gov/cre/ch6.aspA Primer <strong>for</strong> Cultural Proficiency: Towards Quality Health Services <strong>for</strong> HispanicsThe National Alliance <strong>for</strong> Hispanic Healthhttp://www.hispanichealth.arizona.edu/Primer%20<strong>for</strong>%20Culural%20Proficiency%20NAHH.pdfNational Hispanic Council on Aginghttp://www.nhcoa.org/<strong>Serving</strong> Hispanic Families: Home and Community-Based Services <strong>for</strong> People with Dementia and Their CaregiversAlzheimer’s Associationhttp://www.aoa.gov/AoARoot/AoA_Programs/HCLTC/Alz_Grants/docs/<strong>Toolkit</strong>_6_<strong>Serving</strong>_Hispanic_Families.pdfHIV/AIDSThe Aging of HIVNational Association of Social Workershttp://www.socialworkers.org/practice/hiv_aids/AgingOfHIVFactSheet.pdfElderly and HIVNational Prevention In<strong>for</strong>mation Network, Centers <strong>for</strong> Disease Control and Prevention, U.S. Department of Health and Human Serviceshttp://cdcnpin.org/scripts/population/elderly.aspHIV-Associated DementiaFamily Caregiver Alliance, National Center on Caregivinghttp://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=1107Note: Disclaimer from the U.S. <strong>Administration</strong> on Aging (AoA)In<strong>for</strong>mation presented in this document does not constitute an endorsement or recommendation by the U.S. <strong>Administration</strong> on Aging or any ofits employees. The AoA is not responsible <strong>for</strong> the contents of any referenced Web page(s) and does not endorse any specific product or serviceprovided by public or private organizations. The user takes full responsibility <strong>for</strong> accessing any of the referenced links.1 2 2U . S . A D M I N I S T R A T I O N O N A G I N G

Research on Older Adults with HIVAIDS Community Research Initiative of Americahttp://acria.org/clinical/roah_05_05_08_final.pdfPersons Aged 50 and Older: Prevention ChallengesCenters <strong>for</strong> Disease Control and Prevention, U.S. Department of Health and Human Serviceshttp://www.cdc.gov/hiv/topics/over50/print/challenges.htmWhat Are HIV Prevention Needs of Adults Over 50?Center <strong>for</strong> AIDS Prevention Studies, University of Cali<strong>for</strong>nia, San Franciscohttp://www.caps.ucsf.edu/pubs/FS/over50.phpHomelessHomeless and Elderly: Understanding the Special Health Care Needs of Elderly Persons Who Are HomelessHealth Resources and Services <strong>Administration</strong>, U.S. Department of Health and Human Serviceshttp://bphc.hrsa.gov/policy/pal0303.htmHomeless Policy Academies: Improving Access to Mainstream Services <strong>for</strong> People Experiencing HomelessnessHealth Resources and Services <strong>Administration</strong>, U.S. Department of Health and Human Serviceshttp://www.hrsa.gov/homeless/state/index.htmHomelessness Among Elderly PersonsNational Coalition <strong>for</strong> the Homelesshttp://www.nationalhomeless.org/factsheets/elderly.htmlOutreach to People Experiencing Homelessness: A Curriculum <strong>for</strong> Training Health Care <strong>for</strong> the Homeless Outreach WorkersHealth Resources and Services <strong>Administration</strong>, U.S. Department of Health and Human Serviceshttp://www.nhchc.org/Curriculum/module2/module2D/module2d.htmI _______________________________________________________________________________________________________________________________________________________________ImmigrantA Guide <strong>for</strong> Providers: Engaging Immigrant Seniors in Community Service and Employment ProgramsSenior Service America and the Center <strong>for</strong> Applied Linguisticshttp://www.seniorserviceamerica.org/news/cal_guide.htmlU.S. Committee <strong>for</strong> Refugees and Immigrantshttp://www.refugees.org/article.aspx?id=2080&subm=178&area=Participate&L _______________________________________________________________________________________________________________________________________________________________LegalAmericans’ Diversity GuideChapter 4: Laws, Executive Orders, and StandardsNational Association of State Units on Aginghttp://www.nasua.org/issues/tech_assist_resources/national_aging_ir_support_ctr/diversity_guide/diversitychapter4.htmlA T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 123

Cultural Competency LegislationThink Cultural Health: Bridging the Health Care Gap through Cultural Competency Continuing Education ProgramsThe Office of Minority Health, U.S. Department of Health and Human Serviceshttps://www.thinkculturalhealth.org/cc_legislation.aspDurable Powers of Attorney and Revocable Living TrustsFamily Caregiver Alliance, National Center on Caregivinghttp://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=434Legal In<strong>for</strong>mation & ResourcesNational Center <strong>for</strong> Lesbian Rightshttp://www.nclrights.org/site/PageServer?pagename=legal_getHelpLegal Issues <strong>for</strong> LGBT CaregiversFamily Caregiver Alliance, National Center on Caregivinghttp://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=436Legal Issues in Planning <strong>for</strong> IncapacityFamily Caregiver Alliance, National Center on Caregivinghttp://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=437LGBT Elder Law: Toward Equity In AgingHarvard Journal of Law and Genderhttp://www.law.harvard.edu/students/orgs/jlg/vol321/1-58.pdfProtective Proceedings: Guardianships and ConservatorshipsFamily Caregiver Alliance, National Center on Caregivinghttp://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=431Lesbian, Gay, Bisexual and Transgender (LGBT)Community Standards of Practice <strong>for</strong> the Provision of Quality Health Care Services to Lesbian, Gay, Bisexual, and Transgender ClientsGay, Lesbian, Bisexual and Transgender Health Access Projecthttp://www.glbthealth.org/CommunityStandardsofPractice.htmDo We Intend to Keep this Closeted?Edward H. Thompson, Jr., The Gerontologistshttp://gerontologist.gerontologyjournals.org/cgi/content/full/48/1/130Is Your Area Agency on Aging LGBT Friendly?SageConnecthttp://sageconnect.net/intranet/pops/pop_print.cfm?pop=61Is Your “T” Written in Disappearing Ink? A Checklist <strong>for</strong> Transgender InclusionFORGE & Transgender Aging Networkhttp://www.<strong>for</strong>ge-<strong>for</strong>ward.org/handouts/InclusionChecklist.pdfLesbian, Bisexual and Transgender Female EldersNational Gay and Lesbian Task Forcehttp://www.thetask<strong>for</strong>ce.org/downloads/misc/LBTFemaleEldersFactSheet.pdfNote: Disclaimer from the U.S. <strong>Administration</strong> on Aging (AoA)In<strong>for</strong>mation presented in this document does not constitute an endorsement or recommendation by the U.S. <strong>Administration</strong> on Aging or any ofits employees. The AoA is not responsible <strong>for</strong> the contents of any referenced Web page(s) and does not endorse any specific product or serviceprovided by public or private organizations. The user takes full responsibility <strong>for</strong> accessing any of the referenced links.1 2 4U . S . A D M I N I S T R A T I O N O N A G I N G

Lesbian, Gay, Bisexual and Transgender EldersAging Times, National Center <strong>for</strong> Gerontological Social Work Educationhttp://depts.washington.edu/geroctr/AT/2_3/lgbt.htmlLesbian, Gay Male, Bisexual and Transgendered Elders: Elder Abuse and Neglect IssuesFORGE and Transgender Aging Networkhttp://www.<strong>for</strong>ge-<strong>for</strong>ward.org/handouts/tgelderabuse-neglect.htmlLGBT Aging Issues Network (LAIN)An American Society on Aging Constituent Groupwww.asaging.org/lgainLGBT Caregiving: Frequently Asked QuestionsFamily Caregiver Alliance, National Center on Caregivinghttp://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=409Make Room <strong>for</strong> All: Diversity, Cultural Competency and Discrimination in an Aging AmericaNational Gay and Lesbian Task Forcehttp://www.thetask<strong>for</strong>ce.org/reports_and_research/make_room_<strong>for</strong>_allModule <strong>for</strong> Human Behavior and Social Environment SequenceDiversity and Older Adults: Gay Men and LesbiansCouncil on Social Work Education, Cali<strong>for</strong>nia State University, Long Beachhttp://depts.washington.edu/geroctr/Curriculum3/TeachingModule/HBSE_DiversityModule.docNational Gay and Lesbian Task Forcehttp://thetask<strong>for</strong>ce.org/Outing Age: Public Policy Issues Affecting Gay, Lesbian, Bisexual and Transgender EldersNational Gay and Lesbian Task Forcehttp://www.thetask<strong>for</strong>ce.org/reports_and_research/outing_ageRaising Issues: Lesbian, Gay, Bisexual, & Transgender People Receiving Services in the Public Mental Health SystemCenter <strong>for</strong> Mental Health Services, Substance Abuse and Mental Health Services <strong>Administration</strong>, U.S. Department of Health and Human Serviceshttp://www.nami.org/Template.cfm?Section=Multicultural_Support1&Template=/ContentManagement/ContentDisplay.cfm&ContentID=28246Services and Advocacy <strong>for</strong> Gay, Lesbian, Bisexual & Transgender Eldershttp://www.sageusa.org/index.cfmState and Local Directory of LGBT Advocacy and Service OrganizationsNational Gay and Lesbian Task Forcehttp://www.thetask<strong>for</strong>ce.org/activist_center/act_locallyTrans<strong>for</strong>ming Mental Health Services <strong>for</strong> Older People: Lesbian, Gay, Bisexual and Transgender (LGBT) Challenges and OpportunitiesFORGE & Transgender Aging Networkhttp://www.<strong>for</strong>ge-<strong>for</strong>ward.org/handouts/AARP_tran<strong>for</strong>mingMH.pdfA T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 125

Transgender Elders and SOFFAs: A Primer <strong>for</strong> Service Providers and AdvocatesFORGE & Transgender Aging Networkhttp://www.<strong>for</strong>ge-<strong>for</strong>ward.org/handouts/TransEldersSOFFAs-web.pdfTransgender Elder Health IssuesFORGE & Transgender Aging Networkhttp://www.<strong>for</strong>ge-<strong>for</strong>ward.org/handouts/transelderhealth.pdf27 Practical Suggestions to Make Your Organization More GLBT FriendlyBenchmark Institutehttp://www.benchmarkinstitute.org/GLBT/27.htmM _______________________________________________________________________________________________________________________________________________________________Mental HealthCulture, Race, and EthnicityMental Health: A Report of the Surgeon GeneralSubstance Abuse and Mental Health Services <strong>Administration</strong>, U.S. Department of Health and Human Serviceshttp://mentalhealth.samhsa.gov/cre/toc.aspElderly Suicide Fact SheetAmerican Association of Suicidologyhttp://www.suicidology.org/c/document_library/get_file?folderId=232&name=DLFE-158.pdfDepression and Suicide in Older Adults Resource GuideOffice on Aging, American Psychological Associationhttp://www.apa.org/pi/aging/depression.htmlMental Health and Aging Network (MHAN)An American Society on Aging Constituent Grouphttp://www.asaging.org/networks/index.cfm?cg=MHANPromoting Older Adult Health: Aging Network Partnerships to Address Medication, Alcohol, and Mental Health ProblemsSubstance Abuse and Mental Health Services <strong>Administration</strong>, U.S. Department of Health and Human Serviceshttps://www.ncoa.org/Downloads/PromotingOlderAdultHealth.pdfP _______________________________________________________________________________________________________________________________________________________________Previously Incarcerated Persons (PIPS)One in 100: Behind Bars in America 2008The Pew Center on the Stateshttp://www.pewcenteronthestates.org/uploadedFiles/8015PCTS_Prison08_FINAL_2-1-1_FORWEB.pdfNote: Disclaimer from the U.S. <strong>Administration</strong> on Aging (AoA)In<strong>for</strong>mation presented in this document does not constitute an endorsement or recommendation by the U.S. <strong>Administration</strong> on Aging or any ofits employees. The AoA is not responsible <strong>for</strong> the contents of any referenced Web page(s) and does not endorse any specific product or serviceprovided by public or private organizations. The user takes full responsibility <strong>for</strong> accessing any of the referenced links.1 2 6U . S . A D M I N I S T R A T I O N O N A G I N G

R _______________________________________________________________________________________________________________________________________________________________Religion and SpiritualityBody/Mind/Spirit: Toward a Biopsychosocial-Spiritual Model of HealthNational Center <strong>for</strong> Cultural Competence, Georgetown Universityhttp://www11.georgetown.edu/research/gucchd/nccc/body_mind_spirit/index.htmlForum on Religion, Spirituality and AgingAn American Society on Aging Constituent Grouphttp://www.asaging.org/networks/index.cfm?cg=FORSAIntegrating Spirituality into Social Work Practice: The Reflections on Spirituality and Aging (ROSA) ModelCouncil on Social Work Education, School of Social Service, Saint Louis Universityhttp://depts.washington.edu/geroctr/Curriculum3/TeachingModule/Spirituality_ROSAModule.docRuralNational Rural Health Associationhttp://www.ruralhealthweb.org/Rural Assistance CenterCenter <strong>for</strong> Rural Health, School of Medicine and Health Science, University of North DakotaRural Policy and Research Institutehttp://www.raconline.org/P _______________________________________________________________________________________________________________________________________________________________Substance AbusePromoting Older Adult Health: Aging Network Partnerships to Address Medication, Alcohol, and Mental Health ProblemsSubstance Abuse and Mental Health <strong>Administration</strong>, U.S. Department of Health and Human Serviceshttps://www.ncoa.org/Downloads/PromotingOlderAdultHealth.pdfSubstance Abuse and Mental Health Among Older Americans: The State of the Knowledge and Future DirectionsSubstance Abuse and Mental Health Services <strong>Administration</strong>, U.S. Department of Health and Human Serviceshttp://www.samhsa.gov/OlderAdultsTAC/SA_MH_%20AmongOlderAdultsfinal102105.pdfV _______________________________________________________________________________________________________________________________________________________________VeteransCenter <strong>for</strong> Minority VeteransU.S. Department of Veterans Affairshttp://www1.va.gov/center<strong>for</strong>minorityveterans/A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 127

D I V E R S I T YT R A I N I N G T I P SA p p e n d i x HThe list of training tips presented in this appendix represents a starting point <strong>for</strong> users of this <strong>Toolkit</strong>. Agency staffand partners are encouraged to add to these training tips.These tips will assist your agency with training your staff in serving diverse seniors, using the materials in thistoolkit.Establish Training Policies Up FrontIdeally, the facilitator should take at least five minutesto ask participants what type of guidelines the groupshould establish <strong>for</strong> creating both a productive andrespectful learning environment. The goal is not tocreate a list of rules, but to establish a few guidelinesthat foster learning. After the facilitator and participantscreate the list of guidelines, they should post the list ina visible place where everyone can periodically reviewthe guidelines during the training session.Neutralize the DiscussionIt is important that a facilitator remain neutral aboutissues, so the participant group does not perceive anybias in the training. If the participant group perceivesthat a facilitator is biased or has strong preferences<strong>for</strong> certain groups or ideas (whether political, social,religious, or cultural), the facilitator risks losingcredibility with the participant group.Asking open-ended questions allows the facilitatorto appear neutral and without judgment towardparticipants. Often, closed questions “couch” or implya position on or attitude about a topic. Asking openendedquestions helps to neutralize the discussion andcreates an environment in which the participants modelthe behavior of the facilitator.It is important to understand that the act of judgingcan be both a covert and an overt behavior. A facilitatorshould be careful about facial expressions and eyecontact when participants respond. The facilitatorshould maintain an open, pleasant disposition whenthe participants voice opinions. Both verbal and nonverbalbehavior should be neutral.1 2 8U . S . A D M I N I S T R A T I O N O N A G I N G

Avoid “Touchy Feely” StatementsParticipants may assume that diversity training sessionsinclude some level of “touchy feely” activity. Sometimesindicating up front that this will not be a touchy feelytraining session can immediately put some at ease. Letthe participants know that sharing experiences is a veryvaluable learning tool and that it is okay to share. But<strong>for</strong> those who do not want to, that is okay too.Acknowledge “Ouch Moments”Not all topics about diversity are easy to discuss. Aparticipant might express that he/she believes someviewpoints are insensitive and even offensive. This isan “ouch moment.” When a participant shares with thegroup that he/she perceives a particular viewpoint to beinsensitive, the facilitator should simply acknowledgeand thank the participant <strong>for</strong> his/her contributionwithout validating the participant’s position. There aretwo reasons <strong>for</strong> doing this: (1) it demonstrates that thefacilitator is not apprehensive or uncom<strong>for</strong>table aboutaddressing issues that may be controversial, and (2)because the facilitator is not apprehensive, his/hercredibility can be enhanced with the participant group.Do not dwell on the ouch moment; that could sidetrackA T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 129

the training. Simply thank and acknowledge theparticipant <strong>for</strong> sharing his or her viewpoint and makethe participant group aware of varying perspectiveswithout minimizing the statement that was shared.Ask Both Open-Ended and Leading QuestionsOne of the indicators of participant learning is thelearner’s ability to question and engage in self-reflection.A facilitator can initiate this self-reflective process byasking both open-ended and closed questions. Openendedquestions are less confrontational and aredesigned to encourage a learner to think about differentperspectives. For example: “What are your generalfeelings about differences?” This question permits theparticipant to provide a broad range of responses.There<strong>for</strong>e, it may not be perceived as confrontational.Leading questions may be perceived as confrontationalbecause they are direct. For example: “How didyou feel when your outreach ef<strong>for</strong>ts to a particularcommunity weren’t successful?” Because this questionleads the respondent to a specific answer, it may beperceived as being controversial. Both open-endedand closed questions have their learning benefitsand disadvantages. It’s up to the facilitator to choosecarefully which to use in a given situation.Checking-InChecking-in provides a way to monitor both the group’sand each individual’s attitudes and feelings, and canoffer the opportunity <strong>for</strong> the facilitator to adjust thetraining strategy. It can also indicate when a break inthe training is needed to accommodate the mood ortempo of the class.A facilitator may check-in by asking the participantgroup, “Does everyone feel okay?” If the facilitatorchooses to use the check-in strategy, guidelinesshould be established <strong>for</strong> its use up front. If thefacilitator does not set guidelines, the check-in couldprovide an opportunity <strong>for</strong> participants to openlyvent disagreement or frustration and jeopardize themomentum of the participant group’s learning. Be sureto gently express that checking-in does not requiredisclosure regarding why a participant is or is notfeeling com<strong>for</strong>table.Schedule BreaksBreaks provide excellent opportunities <strong>for</strong> theparticipants to talk casually about what they havelearned, or to take time to self-reflect or journal.Providing breaks often helps individual participants toself-manage their emotions and attitudes during thetraining.Encourage JournalingJournaling is the process of allowing quiet reflectiontime <strong>for</strong> individual participants to note feelings,attitudes, and viewpoints during the training session.Journaling also permits an individual to share feelingsin a confidential and com<strong>for</strong>table way. This strategyworks particularly well <strong>for</strong> people who may feeluncom<strong>for</strong>table sharing their thoughts with the otherparticipants.Establish a Learning WallA facilitator can preserve learning or “aha” momentsby having the participants document their responsesto activities on easel paper, and then posting some of1 3 0U . S . A D M I N I S T R A T I O N O N A G I N G

the most important responses in a visible area of thetraining room. The participants can review previousconcepts and reflect on discussions and lessons learnedmore easily when these points are posted on the wall.Icebreakers and EnergizersIcebreakers have traditionally been used at thebeginning of training sessions to help participantsget to know each other. This is important becauseit is difficult <strong>for</strong> people to share experiences withstrangers. Facilitators soon learn that a well thought-outicebreaker will often enliven participants’ interests andenhance learning.Icebreakers in the middle of a training session arecalled energizers. Facilitators should consider usingenergizers to control and lighten the mood or tempo ofa training session. Facilitators can also use energizersas transitional strategies to move the participant groupback into a learning mode following lunch and breaks.Ask <strong>for</strong> Reporting OutFacilitators may ask a learner from each group tosummarize what he/she has learned from the lesson.Reporting out can help clarify the findings of groups,build consensus, and reveal differing perceptions andconclusions.Pass the BallSometimes a facilitator will experience a participantgroup that is extremely talkative to the point thatfrequent interruptions occur in the discussion. Oneway to control a group’s conversation is to pick asmall object (a ball, a toy, or a small action figure) thatrepresents a turn to talk. When an individual finishestalking, he/she passes the object to another memberof the group. Everyone should make an ef<strong>for</strong>t to passthe object to a person who has not previously hadthe opportunity to share thoughts. This ensures thatparticipants with quiet personalities get an opportunityto voice their thoughts too.Collect Anonymous Lessons LearnedSome participants may want to share their insightsanonymously. Such insights can sometimes helpreveal difficult topics in a non-threatening way. Sharinganonymously also allows the participants to takeresponsibility <strong>for</strong> the “elephant in the room” andenable the group to acknowledge a difficult topic withrespect and without controversy.Thank ParticipantsSometimes it takes a lot of courage <strong>for</strong> a participant toshare what was learned. When anyone contributes to theconversation, particularly when a personal experiencewas shared, facilitators should thank the participant <strong>for</strong>contributing.A T O O L K I T F O R S E R V I N G D I V E R S E C O M M U N I T I E S 131