Cultural Sensitivity: Counseling and Serving Hispanic/Latino Families Effectively

Learning Outcomes

After this course, participants will be able to:

• Identify the 5 critical questions and how they can be used to assist in counseling Hispanic/Latino families.
• Explore personal triggers and tools that can diffuse negative reactions regarding cultural differences.
• Develop an action plan on how to work towards cultural sensitivity and competency.
• Identify the Hispanic demographic in the United States and at least one cultural value of this population.

Introduction

Thank you for joining us as we discuss cultural sensitivity in counseling Hispanic and Latino families. Our mission at MED-EL is to overcome hearing loss as a barrier to communication and quality of life. In order to do this for everyone in the U.S., we recognize the breadth of cultural diversity that exists in our country and believe in the importance of developing culturally sensitive and cultural sensitivity so that everyone can receive the benefit from our hearing devices equally. As co-presenters, throughout the presentation today we will be sharing stories and clinical experiences that reflect our personal journey to cultural sensitivity. 

Annie's Journey

I am an audiologist and the consumer engagement manager for MED-EL's bilingual program. Prior to joining MED-EL, I was a pediatric cochlear implant audiologist for a clinic serving primarily Spanish speaking families. I am a Hispanic Latino woman, and at this clinic, I experienced what it was like serving the Hispanic population as a professional. 

My personal journey to cultural competence began where I was born, in the Dominican Republic. My family moved to New York City when I was very young. Shortly after moving to New York City, my family and I moved to Long Island, New York, to a town called Massapequa. At that time, we were the only Spanish speaking individuals in our town. I remember going to school and feeling a bit isolated. I had no one who spoke my language, looked like me or even ate the same lunch as me. For lunch, I would have rice, chicken, beans and my favorite soup called sancocho, whereas my friends' lunches consisted primarily of peanut butter and jelly sandwiches. Needless to say, my friends looked at me like I was different and a little weird. As a child, of course, all we want to do is fit in. Without knowing it, my sweet friends were not sensitive towards me and it made me feel a little bit self-conscious. 

A few years later, my friend Melissa joined my school and I remember looking at her and meeting her. She spoke Spanish and looked just like me. That sense of relief and the feeling of home was amazing. Looking back on my experience as a professional, I didn't want anyone to have the same feeling I did at the lunch table. I want our patients to have the same sense of relief I felt when I met Melissa. I carried this experience over to my services for families that came into the clinic, regardless of their background.

Myriam's Journey

I'm a doctor of audiology and I have worked in the field of cochlear implants for over 13 years. I'm the consumer engagement program manager for our bilingual program at MED-EL. My journey towards culture sensitivity began with my parents. They taught me the importance of being Colombian and what it meant to embrace our culture. Both my parents are from a beautiful, warm city called Barranquilla, Columbia, which is also rich in culture. They decided to leave Columbia in their late 20s, and they came to the United States for a better life. They moved here not knowing the language and faced many struggles. When they moved to the United States, they arrived in New York where the winters were brutal and getting a job was impossible unless you spoke English. They worked in factories for several years until they decided to look for a place that was more similar in climate to their home, possibly a place with a community of Spanish speaking people so they'd feel a little bit more at home. In the late 1970s, they moved to Miami. They felt the living conditions there were not as harsh as New York and they were able to find a small community of people that spoke Spanish. At the time, they were able to open up their own business that sustained our family through private school and even college. Although in the late '70s, most people in Miami primarily spoke English, an influx of Cuban immigrants changed the culture of Miami forever, even until this day. Although the Colombian culture is slightly different than the Cuban culture, my parents were happy to be around people with at least similar interests and beliefs.

Soon after my parents moved to Miami, I was born. My parents placed me in a daycare at the age of three, which was not very common in our culture. It was an English-speaking daycare, and about a week after I started, the teacher expressed concerns that I had issues with interacting with other children. I didn't engage in much social play and I seemed isolated. They were worried that I might be clinically depressed at the age of three. I barely spoke at school and when I did speak, I would say constantly "piscina, piscina" which means "pool" in Spanish, because I couldn't pronounce the word "oficina", which means "office". All I wanted to do is be in my parent's office. The teachers suggested to my parents that I should see a psychologist, and my parents were distraught. The little English that they understood, they thought there was something wrong with their daughter.

They took me to the psychologist and had me evaluated. In the end, they determined that there was something wrong with me: I didn't speak English. I didn't understand the culture around me. I was growing up in a Spanish-only home and therefore didn't relate to other children. They ate different things, spoke a different language, they looked different than me. The psychologist suggested to my parents that I should probably be placed in a different daycare where at least one of the teachers spoke Spanish. They transferred me to a different daycare. At that time, the daycare seemed very similar to a home environment. I blossomed. My whole personality changed. I began eating, playing with other children and interacting. My parents now look back at the story and they laugh, but oftentimes they tell me at that moment, it was very concerning for them. They said they felt awful that they may have caused me to have this behavior or why did they put me in a different school. They felt that it was their fault. Now as a mother myself, I can imagine how scary this would be if I was unable to express what I felt to the teacher or any concerns that I might have about my daughter and my son. Hearing these stories growing up, that was the first time I realized that I was different. My family was different. We were different because we were Latinos and Hispanics.

Hispanic vs. Latino

Throughout this presentation, you'll hear us use the words Hispanic and Latino. For the clarity's sake, we thought it may be helpful to define these terms and make the distinction between them. While the terms Hispanic and Latino are sometimes used interchangeably, Hispanic is a narrower term that only refers to persons of Spanish speaking origin or ancestry. Latino is more frequently used to refer generally to any one of Latin American origin or ancestry, including Brazilians. Latino is more of a geographic term. Interestingly, there is even a Spanish-speaking country in West Africa called Equatorial Guinea. Since 1884, their primary language has been Spanish, and as such, they're technically considered Hispanic.

Culture and Cultural Sensitivity

Next, we will discuss the components of culture and the meaning of cultural sensitivity. Culture is comprised of food, music, activities, religion, and sports. It also includes dialect and phrases, such as the Spanish phrase "que bacán", which means "how cool". It's interesting because Myriam is from Colombia and she uses "que bacán", and I'm from the Dominican Republic and we use "que bacáno" with an "O". These phrases mean the same thing, but they're slightly different. Even within the Latino countries, there are differences in dialect, but just because they're different doesn't make either one of them wrong.

Cultural sensitivity is defined as knowing that differences and similarities exist between cultures and that they do have an effect on our values, learning, and behavior (Stafford et al., 1997). Being culturally sensitive allows you to understand that we may have different opinions or experiences and our backgrounds may be different than other people. Cultural sensitivity allows us to recognize these differences as simply differences. We can be looking at the same thing or person and have completely different approaches on how we view them. For example, a dog can be viewed in many different ways to different people. A dog can be considered a person's best friend, or a purse accessory, or simply an alarm clock. We all tend to have our judgments based on our own experiences and what is meaningful to us.

Importance of Cultural Sensitivity

Cultural sensitivity is important because, in the U.S., the Hispanic population is growing. Over 50% of people in California, Florida, and Texas are Hispanic. Furthermore, it is projected that the percent of the Hispanics in the U.S. will dramatically rise from approximately 19% to 28% by the year 2050 (https://www.pewhispanic.org/2013/08/29/mapping-the-latino-population-by-state-county-and-city/). The census reports that by 2050, the U.S. may have up to 102.5 million people that are Hispanic or Latino (https://www.census.gov/newsroom/facts-for-features/2015/cb15-ff18.html). That is approximately one in every four Americans that will speak Spanish. Currently, there are 8% of Hispanic Latinos that have hearing loss in the U.S. If the projections hold true, as the Hispanic population continues to rise, there will be approximately 8.2 million people with hearing loss in this population by the year 2050.

This is important because it will affect us greatly as hearing care professionals. This is important to MED-EL, and we have made it a priority to invest in resources to better understand the unique needs of the Hispanic-Latino population and provide the appropriate support.

In order for us as clinicians to begin working towards cultural sensitivity, let's explore a day-to-day interaction with one of our patients. Imagine this scenario: After a long day, you're tired and you're feeling mentally exhausted and overwhelmed at work. You have back-to-back appointments, and one of your patients arrives 40 minutes late. Not only is the patient late, but she has also brought all four of her children to this appointment, one of whom is tired, cranky and crying. What do you do? This is an example of one of the "triggers" that we may experience on a daily basis.

Triggers

Triggers are defined as emotions that may negatively affect the way we behave or treat others. I was working in New York City in one of our cochlear implant programs. I had a father come in and he was extremely quiet and reserved. I perceived that the father was disinterested in what I was saying and what was happening during his son's clinical session. His silence seemed very rude to me. Being Hispanic, I am very friendly and talkative, and I enjoy interacting and greet others by hugging. It was highly uncomfortable for me to have this immense silence and distance between the father and me. Because I felt so uncomfortable with this silence, I wanted to speak even more to overcompensate for it, which irritated the father even more. As a result, I was unable to develop a trusting relationship with the father. We could never seem to get past that discomfort. We each perceived the other as disrespectful. In reality, and unbeknownst to me, his interaction with me was based on his religious practices. Their culture had specific restrictions on how to interact with persons of the opposite gender. This is an example of how we have a tendency to create a story about what we believe others are thinking or why they're behaving a certain way. There is a point where we have to detach ourselves from our own story in our own head and face the reality of the situation.

Take a few seconds to think about your own triggers. What are the things that may cause discomfort or something that you automatically feel irritated about in the clinic? What may have held you back from being culturally sensitive? Now that you have that trigger identified, how did that make you feel? What did you do at that moment when you experienced that feeling? What was the cost? Lastly, what was the reality of the situation? The key when we're doing this activity is to self reflect. It's important to try to differentiate what happened from the stories that we're telling in our head and shake them off so we do not shift our way of being. When we gain the ability to stay focused on what happened and we combat the distortions in reality caused by our own thoughts, despite the differences in culture, the closer we move to cultural competence. The ability to differentiate what happened from a developing story in our head crosses all cultural barriers, and we would like to establish this as a foundation to remaining culturally sensitive. It's important to remember that despite our triggers, at the end of the day, we do have a social responsibility and a moral obligation to help others. This obligation we have to serve effectively and competently can be fully realized through deep reflection, by asking ourselves as clinicians some simple yet critical questions based on our knowledge of this target culture. We can move towards being culturally sensitive.

Five Critical Questions for Healthcare Providers

Today, we have five questions for you to consider with the hopes that you might start to generate your own reflective questions. For the purposes of today's presentation, we're specifically focusing on Spanish speaking families, but some of these critical questions can be used across cultures.

Question #1: Have I given this family time to seek counsel from their family unit?

This first question is important to consider in the Hispanic population because of a term that we call familismo. Familismo is a Latino cultural value that refers to the importance of family loyalty, closeness, a contribution to our immediate and extended family unit. Oftentimes, we make decisions as a whole family unit, not just as an individual. We also put the needs of other family members above our own. When I was growing up, one of my favorite television shows was called "¿Qué Pasa, USA?" It was the most similar show that I could ever relate to growing up. This family consisted of a group of Cuban immigrant parents, children, and grandparents, all living in the same household. They pretty much enacted the term familismo. They were trying to adapt to the American culture while having deep Hispanic and Latino values. Familismo embodies the idea of family, support, protection against one's life struggles. It provides an immense sense of belonging. Understanding this concept of familismo and how deeply rooted it is in our culture will help us as professionals effectively manage the families who come into our clinics. Find out who is the primary decision maker or who will be the child caretaker during the day while mom and dad are working. Grandparents are often heavily involved, therefore, finding out this information and adjusting appointments to invite these family members will aid in successful outcomes.

Question #2: Does this family think I'm too much of an authority?

Healthcare back in our countries is very different than in the United States. Oftentimes, the family doctor has been the family doctor for generations, and in essence, the doctor becomes a part of the family. They need to develop this sense of family and trust in a medical environment, similar to in their country. This will open up lines of communication. You may have witnessed that sometimes, the Hispanic population may not ask a lot of questions to the healthcare provider because there is a level of fear or discomfort.

We also have to consider the language barrier and the family's lack of knowledge of the healthcare system, especially if they recently arrived in the U.S. They don't know what they're eligible for or how to even start the process for applying. Healthcare and insurance in the U.S. are difficult to navigate even if you speak English. If there is a language barrier, there may be a delay in appropriate and timely healthcare and even follow up.

One strategy to consider when working with these families is using personable body language. In addition, perhaps you could refrain from wearing a white coat, so that you may be perceived as more inviting and less authoritative. Also, keep it simple, and explain things one step at a time.

Question #3: Does my environment say "You're safe and welcome here?"

Body language is important, especially when you do not speak the language of your patients. As professionals, this is something that you can control that will impact how your patient perceives their experiences.

In 2009, a professor by the name of Mehrabian conducted a study to analyze communication (Mehrabian, 2009). They found three common factors that helped land a message for the listener: body language, tone, and content. Which one do you all think had the biggest impact? It was body language. People may not always remember what you said, but they will certainly remember how you made them feel. As such, it's critical that we create a sense of community.

Think of the places in your community that you visit regularly and why. Then ask yourselves what kind of messages are the images on the wall of your clinic or school sending to the Hispanic community? Do the surroundings feel welcoming? How are you greeting patients when they arrive? Community is very important as it allows us to relate to others in a welcoming environment. For example, I'm a part of a virtual support group and I enjoy going because I can relate to others and their experiences, and they make me feel welcomed.

I wanted to share this quote that is attributed to Theodore Roosevelt: "Nobody cares how much you know until they know how much you care." We are very knowledgeable, but more importantly, we need to cultivate compassion and let our patients know we care. It's in the details like having pictures in our office that represents their culture or even having reading materials in Spanish that are readily available.

One strategy that may help create a sense of community in your clinic is to hire multicultural staff. Furthermore, you could provide skilled services in the patient's home language. Finally, it may be beneficial to create family support groups where they can meet others who share the same cultural values. Here at MED-EL, a part of our job is to connect with families, as well as connecting families to each other, because we want to build that community and that support.

Question #4: Do I have a clear perspective on what this family is going through?

In order to gain perspective, we need to seek to understand the family's situation and consider what is important to them first. Consider gaining knowledge on factors such as socioeconomics, education, and English proficiency, as these have an enormous impact on a person's health beliefs and behaviors. Knowing what is a priority for them will guide us on how to better serve them so that they are successful. After we seek to understand their situation, then we can seek to be understood.

Empowering them will encourage and build relationships just like a family member would, so that they feel comfortable sharing their fears, struggles, and hopes. I recall when I worked in the clinic as a cochlear implant audiologist, we always wanted to be able to guide these families in getting a cochlear implant. We felt that that should be the most important thing. However, oftentimes, the more that we get to know these families and ask the right questions and develop that relationship and connection with them, the more we realized that there were a lot of other struggles that may have been more important to them. I don't know their home life and their struggles and fears. Being able to step back and truly get to know your families and listen to what they're trying to say is extremely important.

We must also consider their values. We have to have a better understanding of their family dynamics, and who is involved in making those decisions. As stated earlier, it is essential to create a safe environment so that they feel comfortable in having open discussions. Ask open-ended questions, such as "How many family members live in your home?" I remember the first time I had to ask that to a family. It was very uncomfortable for me. As an audiologist, I don't recall getting trained on knowing how to ask those questions, but it's important to get to have an idea of what their family home life is like. Oftentimes, we have to listen a little bit more and speak a little bit less, even though our role is to provide education and information about hearing loss, but we also need to know what do they believe is their best choice. We do this by asking open-ended questions. I did learn over time and through the years that asking these open-ended question is truly a great way to encourage participation and empowerment from these families. It will also provide us with great insight as to what they're thinking.

We can ask simple questions like, "What does your typical day look like?" You'd be surprised at what time people put their children to sleep, what they do during the day, who is taking care of them or how many different people may take care of them. Another good question to ask is "What do you know about your child's hearing loss?" Simply ask them what is the most important thing for you and your child right now. Sometimes those questions will lead to different answers and you will gain a lot of perspective of what they're going through. 

During the time that we're asking these open-ended questions, we must also take a look at ourselves as clinicians and ask some of the questions to ourselves. One of our own reflective questions that we've reviewed is "Do we know what the family is going through by asking these questions." This is also consistent with motivational interviewing practices with which some of you may already be familiar. When we do that, we can be mindful of the different ways to listen, which can be difficult. I love to talk, so it was hard for me to develop that listening skill.

Types of listening. Listening can be categorized in two ways: reactive and committed.

Reactive listening. The practice of reactive listening comes from a mindset of "I am right and you are wrong." When we are in this state, we're waiting for an opening to argue our point or thinking of a rebuttal. You have to learn how to listen and get that information to see what we can do better. Reactive listening may also occur when you are uncomfortable, and as a result, you distract yourself with other things.

Committed listening. The practice of committed listening allows us to give our full attention to the speaker, being curious and willing to be influenced by setting aside our prejudices, preconceived conclusions and judgments. Committed listening is when you're truly giving a person your focused and full attention, in order to provide them with the appropriate clinical service. It involves understanding what they are saying and being able to ask questions back. The following sequence will help facilitate commited listening: acknowledge, clarify and respond. One of the first principles of committed listening is giving up the need to be right. When you give up the need to be right or thinking that we know better than the families, we can maintain a nurturing and positive manner, despite our differences. It's the ability to face these differences that is our gauge for how we know we are moving toward cultural competence. Think about the possibilities that would be available if we came from a place of not knowing and from a place of simply seeking the truth that help is needed. We can deliver the information in a sensitive manner and provide encouragement and support. If we slow down and pay attention and give the families a bit more time to express what they're feeling, we will notice that there's a lot of information we can obtain from them. We have to find a way to be reliable and allow ourselves to monitor what we're feeling in response to their questions. That way, we can give the families better tools so that we can set them up for success. First, we ask. Next, we listen. Then, we provide tools based on what they need. 

Question #5: Do I have the support tools I need?

If your organization does not already have one, I suggest that you form a culturally specific support team (CSST). The CSST is comprised of people who are able to represent various cultures and ethnic groups, preferably people who are, in fact, members of that specific group. This may not always be possible, and when it's not, the next best thing is to have someone who is familiar with and sensitive to the culture or ethnic group and its customs.

The role of the CSST is to help educate caregivers and providers about the target culture's customs and possibly associated needs that will play a role in their treatment. As an example, in the clinic, I worked very closely as a CI audiologist with auditory verbal therapists and other disciplines. Often, one of the recommendations for pediatric CI patients was to read a specific number of books, because we want to foster communication. If we recommend that they read 10 books a night, that means they're going to get language bombardment and exposure, as well as interaction with their family and whoever is reading to them. That interaction will, in turn, foster speech and language development.

We came to realize that many of our patients in Miami were not as successful with the reading recommendation. Growing up Latina and Hispanic, we do read to our children, but reading isn't as embedded as it is in the American culture. Why not take those goals that we want to achieve with reading, but apply it to a different scenario that comes naturally to our culture: the dinner table? Research shows we are more likely to sit together as a family to eat food and share a meal. Food is huge in our culture. We unite around the dinner table. Why not take those goals for language exposure and instead of reading, translate that interaction to the dinner table? The goal is the same, but the route is different. The CI recipient will be more successful and it will come more naturally to them. Having a CSST can help hearing care professionals develop different strategies to achieve the ultimate end goal.

Resources/Tools

In addition to ASHA's Practice Portal, there are other valuable tools and resources that can assist you on your path to cultural sensitivity:

• The University of Arkansas for Medical Sciences (UAMS) has a Center for Diversity Affairs that offers great resources with detailed overviews on key issues related to cultural competence. It can be found by going to the UAMS website (https://www.uams.edu/) and under the "Academics" tab, select "Departments and Divisions" and you will be able to choose the Center for Diversity Affairs. It also includes state laws and legislation, as well as self-assessments and interactive web-based tools that evaluate the knowledge of culturally and linguistically diverse populations and the prevalence of hearing loss, the causes of hearing loss. It also has an open book assessment of 25 questions, which is a checklist and a guide for self-awareness and reflection when treating patients to improve your sensitivity and provide better services.
• The Ida Institute is an independent not-for-profit organization working to integrate person-centered care and hearing rehabilitation. They aim to enable people with hearing loss to take an active role in their care by expressing their needs and preferences (https://idainstitute.com).
• The Care Project (https://www.thecareproject.com) is also a not-for-profit organization that is geared toward supporting both families via events and professionals. They offer one- and two-day workshops for professionals and are primarily focused on sensitivity issues related to the family's emotional journey. They also have workshops and events with a focus on Hispanic families, so this is something that you all can recreate in your areas in your clinic as well.

MED-EL's Bilingual Program

Another tool is MED-EL's bilingual program. Ours is the first program in the industry created to meet the unique needs of the Spanish speaking population in the U.S.  Our goal is to empower and equip families with the support and education they need, regardless of where they are in their hearing journey. We are here to help upon diagnosis, during the process of CI candidacy and after implantation, because it is a lifetime journey. We're here to help before, during and after their CI or bone conduction journey in their native language. MED-EL's initiative to better meet the needs of the Hispanic population has many facets, including:

• Increasing awareness
• Empowering families
• Bridging cultural gaps and encourage cultural competency
• Supporting the entire family so that they become our family

In order to make families feel welcome and comfortable asking questions, we offer events and do educational presentations so that they may gain further knowledge or expand their existing knowledge on hearing loss and cochlear implants. For example, we educate them on the proper use of their CI or hearing related equipment, language development, and anything that they may have questions about. The topics of these events vary greatly, from music, family life, and as we were discussing earlier, the importance of reading out loud. Our goal is for them to feel that they have that community and support. We want them to realize that we understand where they come from. Growing up Latina, we know what it is to have our entire family wanting to be involved in decisions. As such, we frequently welcome the entire family at these events. This is a way to offer extended support that is greatly needed for this community.

Currently, we're also developing Spanish materials. We've expanded our availability of what we can offer these families, and we also want to continue to develop our materials to ensure that they are culturally representative and linguistically appropriate for this population. We receive many requests from professionals across the country asking if they can use our materials for patients in their own clinics. We strive every day to make sure that we are creating these materials for your accessibility because we're here also to support the professionals who are working with Spanish speaking families.

It is important to know the culture, and given our clinical experience, we are very in tune with what our patients commonly ask or have asked in the clinic and what they're yearning to learn more about. We integrate that information and that knowledge in all of our Spanish materials so that the information is not only educational but also practical and relatable. In addition, as part of the bilingual program, we want to make sure that our information is not directly translated from existing pieces. We want to make sure that we incorporate the cultural aspect. We're also taking into consideration what clinicians may want as support for their counseling, whether on the general topic of hearing loss or explaining the differences between cochlear implants and hearing aids, and the different types of therapies that exist. These families are very eager to learn. For clinicians who are working with this population, whether frequently or infrequently, any requests that we get, we assess would be the best for these clinicians. At any point in time, if you have any recommendations for counseling or educational tools that you feel would be beneficial, please let us know. We are responsive to those requests as we understand how difficult it is to find resources that resonate with this population.

Next Steps: Moving into Action

As we wrap up, we are going to take a look back at our five critical questions and use them to build an action plan so that we can better assist this population. 

1. Does this family think I'm too much of an authority? For example, when I greet these families, I am very cognizant of not wearing a white coat, for fear that they would not want to speak to me or that the child would cry and run away from me.
2. Does my environment say you're welcome here? Be aware of your environment and the posters and artwork hanging in your clinic. Do they represent diverse cultures? For families that have a language barrier, they're hyper-focused on their environment and they're observing what's around them. It is also important for us to use appropriate body language, as well as being observant of families' body language.
3. Have I given this family time or opportunity to seek counsel from their family unit? In my experience, there have been many cases where parents were hesitant to make decisions to move forward with hearing aids or CI surgery. I would become frustrated until I realized that it was because their grandfather still did not accept the hearing loss, or because someone close to the family was influencing their decisions. It is important to allow them time to seek counsel from other family members because that's an important aspect of Hispanic and Latino culture.
4. Do I have a clear perspective on what the family is going through? We can't know what families are experiencing unless we sit down and ask open-ended questions. On one occasion, a woman came in with her child and she was inside the booth while we were testing. I could tell that the mom's demeanor was different than usual. I asked her if everything was okay, and she responded that, in fact, she was not okay. That allowed us to have a conversation because as the child's mother, she needed support. It was nice to be able to start that discussion simply by asking an open-ended question.
5. Do I have the tools and support I need to effectively do my job? As we demonstrated earlier, there is an abundance of tools available for you to use. At MED-EL, we also continue to create materials that will resonate with this population.

These are some key concepts that we've used clinically with our own Spanish speaking patients. These questions have allowed families to be able to open up and make these connections, in order to bridge that cultural gap.

What Was Your "Aha" Moment?

During the course of this presentation, did you have an "aha" moment where you learned something new about this culture? If you did have an "aha" moment, did that make you curious to learn more about specific aspects of the culture? For example, perhaps you never recognized the need for more culturally sensitive materials and pictures in your office or clinic. In what areas do you think it would be beneficial for you to gain more knowledge? It might be something simple, such as knowing the differences in dialects. We all speak Spanish, but our vocabulary and dialect will vary, depending on our country of origin. Perhaps you want to learn a bit of Spanish, such as keywords that will improve communication with patients. Now that you have learned about cultural differences that exist, think about what you're going to do differently. How are you going to take this cultural knowledge and implement it in your day-to-day clinical experience? We hope that your attendance at this presentation will generate a new set of reflective questions so that we can move toward being more culturally sensitive.

Summary and Conclusion

In closing, cultural sensitivity is an awareness that differences and similarities exist, and they do have an effect on our values, learning, and behavior. This leads to cultural competence, which is our ability to effectively deliver services that meet the social, cultural, and linguistic needs of our patients. A culturally competent system can help improve outcomes and quality of care and can contribute to the elimination of racial and ethnic health disparities. As stated earlier, although our topic today was specifically geared to Spanish speaking families, many of these concepts can be applied across all cultures. We are all from different backgrounds and we have a lot to learn from each other. We need to learn how to better position ourselves in order to respond to these issues of diversity so that we can properly serve these families. Specifically here at MED-EL, we continue to improve our bilingual program as we work with clinicians and families. We truly hope that you will join us on this journey. Thank you so much for your participation. 

References

Stafford, J. R., Bowman, R., Ewing, T., Hanna, J., & Lopez-De Fede, A. (1997). Building cultural bridges. Bloomington, IN: National Educational Service.

Mehrabian, A. (2009). "Silent messages"- a wealth of iInformation about nonverbal communication (body language). https://www. kaaj. com/psych/smorder.html.