Module Five

The Cultural Context of Prevention

### Time {#time .HeadInfSheet}

The anticipated time for this module is 3 hours.

### Learning Objectives {#learning-objectives .HeadInfSheet}

Participants will be able to

-   Understand key definitions related to culture and diversity

-   Share parts of their own culture and learn about parts of other
    participants' cultures

-   Discuss the dominant cultural values and beliefs in U.S. society
    that both encourage and discourage alcohol, tobacco, and other drug
    use and abuse

-   Discuss dimensions and elements of culture and diversity and their
    relationship to the strategic prevention framework (SPF)

-   Describe why and how prevention professionals should be
    knowledgeable about and committed to addressing issues related to
    diversity

-   Describe why and how prevention programs should be responsive to the
    diverse needs, histories, cultures, and strengths of all groups that
    the program serves

-   Describe key skills and practices that utilize diversity as an asset
    in prevention program planning and implementation

### Materials and Preparation {#materials-and-preparation .HeadInfSheet}

Be ready to use the following information and work sheets:

-   **Some Elements of Culture**

-   **Key Definitions in Diversity Work**

-   **Similarity and Diversity**

-   **Values of Dominant U.S. Culture**

-   **Our Records**

-   **Adultism**

-   **Requirements of a Culturally Effective Prevention Professional**

-   **Building Culturally Effective Prevention Programs**

-   **Expanded Community Case Study\[Ed. Note: This piece is
    missing.\]**

-   **Where to Go to Find Information About Communities**

-   **Assess Your Own Organization**

### INFORMATION SHEET {#information-sheet .HeadInfSheet}

# Some Elements of Culture 

**Culture** is the collectively agreed-upon knowledge, experience,
values, ideas, attitudes, skills, tastes, and techniques that are passed
on from more experienced members of a community to new members. Language
is a major transmitter of culture. Carriers of culture include families,
religious organizations, peer groups, neighbors, and social groups.

Continuous interplay between individuals, their perceptions, attitudes,
assumptions, and behaviors, and their environment and social
institutions creates dynamically evolving cultures and subcultures,
where the whole is more than the sum of its parts. That is, groups are
bound together by the interactions of their members, as well as by their
similarities to each other and differences from other groups. Culture is
not static; it is constantly changing in response to the internal
interaction of its members, to interaction between different cultural
groups, and to the needs and threats experienced by group members. There
is often a difference between the ideals put forth by a culture and the
way that the culture is expressed in daily living. In addition, an
individual can be identified in a number of ways that are independent of
each another. This enables a person to participate in more than one
culture simultaneously.

Listed below are some of the many elements that are defined by a
person's culture(s).

-   **Aesthetics** (attitudes and behaviors related to literature,
    music, dance, art, architecture)

-   **Ceremony** (attitudes and behaviors related to what a person
    should say and do on particular occasions)

-   **Communication forms** (attitudes and behaviors related to personal
    space, greeting, voice tone, eye contact, touch, smiling, facial or
    emotional expression, gestures, humor)

-   **Ethics** (attitudes and behaviors related to honesty, fairness,
    principles)

-   **Folk myths** (attitudes and behaviors related to heroes,
    traditions, legendary characters, superstitions)

-   **Formality versus informality** (attitudes and behaviors related to
    ways members address each other)

-   **Gender roles** (attitudes and behaviors related to expectations of
    people based on their sex)

-   **Generational interrelationships and kinship patterns** (i.e.,
    independent, interdependent, dependent, extended, augmented)

-   **Grooming and presence** (attitudes and behaviors related to
    physical appearance, such as hairstyle, cosmetics, dress)

-   **Health and medicine** (attitudes and behaviors related to
    wellness, sickness)

-   **Individual orientation versus group orientation** (attitudes and
    behaviors related to whether the welfare of the individual or the
    unity of the group takes precedence)

-   **Language and linguistics** (language, wording, and structure of
    speech)

-   **Recreation** (attitudes and behaviors related to how people spend
    their leisure time)

-   **Relationship focus versus goal focus** (attitudes and behaviors
    related to whether the maintenance of interpersonal relationships or
    the achievement of goals is more important)

-   **Relationships** (attitudes and behaviors related to connections
    between family members, friends)

-   **Rewards and privileges** (attitudes and behaviors related to
    motivation, merit, achievement, service)

-   **Rights and duties** (attitudes and behaviors related to personal
    obligations, voting, taxes, military service, legal rights)

-   **Sex and romance** (attitudes and behaviors related to courtship,
    marriage)

-   **Spirituality** (attitudes and behaviors related to spirituality,
    prayer, purpose in life, the possibility and type of afterlife)

-   **Status** (attitudes and behaviors related to people of different
    rank, e.g., age, wealth, office, fame)

-   **Subsistence** (attitudes and behaviors related to providing for
    oneself and providing for the young and the old, also related to who
    protects whom)

-   **Taboos** (attitudes and behaviors related to doing things against
    accepted norms)

-   **Time** (attitudes and behaviors related to being early, on time,
    or late; concepts and relational nature of past, present, future)

-   **Values** (attitudes and behaviors related to what is desirable or
    good)

-   **Values inherent in symbols, numbers, colors, directional
    orientation**

Gonzalez, V.M., Gonzalez, J.T., Freeman, V., & Howard-Pitney, B. (1991)
Health Promotion in Diverse Cultural Communities: Practical guidelines
for working in and with diverse cultural communities. Health Promotion
Resource Center, Stanford Center for Research in Disease Prevention in
cooperation with the Henry J. Kaiser Family Foundation.

### INFORMATION SHEET {#information-sheet-1 .HeadInfSheet}

# Key Definitions in Diversity Work

The following list of definitions provides a basic vocabulary of terms
that are central to understanding and discussing issues of culture and
diversity.

**Adultism:** The belief that adults are better than young people and
are entitled to mistreat and disrespect young people simply because they
are young.

**Ageism:** The belief that the elderly are less important and valuable
than other age groups.

**Ally:** A member of a historically more powerful group who speaks out
against discrimination and prejudice directed at "minority" groups.

**Culture:** The collectively agreed-upon knowledge, experience, values,
ideas, attitudes, skills, tastes, and techniques that are passed on from
more experienced members of a community to new members.

**Cultural diversity:** The shared values, beliefs, and norms that vary
between groups.

**Cultural competence:** The understanding and appreciation of cultural
differences and similarities within and between groups. A willingness
and ability to draw on community-based values, traditions, and customs
and to work with knowledgeable persons of and from the community in
developing prevention strategies. (CSAP 1994).

**Disability:** A limitation, difference, or impairment in one's
physical, mental, or sensory capacity or ability.

**Discrimination:** A society-wide, systematic manner of treating
individuals differently due to their status or membership in a
particular group.

**Diversity:** Differences in qualities, attributes, or conditions that
are socially defined as significant.

**Ethnicity:** Membership in a group of people sharing learned culture
and language.

**Gender:** Cultural concepts about the behaviors and attitudes that are
appropriate for each sex (i.e., what is considered masculine and what is
considered feminine).

**Heterosexism:** A societal or community bias whereby cultural
institutions and individuals are conditioned to expect others to live
and behave as heterosexuals.

**Historical trauma:** The cumulative effects of emotional and
psychological wounding over a person's life span and across generations,
emanating from massive group trauma experiences (e.g., the Holocaust
during World War II or the forced relocation of Native peoples during
the 1800s). Individuals and communities may be at risk for
trauma-related effects even if they did not personally experience the
related events.

**Minority:** The smaller in number of at least two groups. In this
context, "minority" refers to groups with less power and fewer
opportunities. Although commonly used, this term is starting to be seen
as derogatory.

**National origin:** The country in which a person was born.

**Prejudice:** A belief that someone deserves more or less access to
resources based on their membership in a certain group.

**Race:** Membership in a group of people sharing inherited physical
characteristics that are socially and politically defined as
significant.

**Racism:** The belief that some ethnic or racial groups are inherently
superior to others.

**Sex:** One's biological status as male or female.

**Sexism:** The belief that one sex is innately superior to another.

**Sexual orientation:** Describes the sex(es) of people toward whom one
feels romantically or sexually attracted (i.e., heterosexual, bisexual,
gay/lesbian).

**Socioeconomic status:** One's social position related to economic and
lifestyle characteristics and created by income, education, profession,
etc.

**Stereotype:** A highly simplified conception or belief about a person,
place, or thing, based on limited information.

Center for Substance Abuse Prevention. (1994, September). Following
specific guidelines will help you assess cultural competence in program
design, application, and management. /CSAP Technical Assistance
Bulletin. /Rockville, MD: U.S. Department of Health and Human Services,
Substance Abuse and Mental Health Services Administration.

### INFORMATION SHEET  {#information-sheet-2 .HeadInfSheet}

# Similarity and Diversity

Our relationships with others require a constant balancing act between
our differences and similarities. All people everywhere share much in
common. In some ways we are more similar than different. We all have the
same basic needs. Biologically, we are all the same species. We have
generations of families, heritage and history, relationships with
friends and others, values that direct our lives, spirituality, beliefs,
patterns and habits, traditions, hopes, and dreams for ourselves and for
our world. We seek meaning and harmony in our lives and connectedness in
our relationships. We eat, work, rest, play, wear clothing, express
creativity, laugh, give, and receive. The specifics of how we manifest
these things and the differences in the attributes of the persons
performing these manifestations create the diversity in our world today.

Any given community contains varied ways of thinking, believing, and
acting that represent the many cultures and diverse groups that exist
within that community. Although communities have unique cultural
profiles, all communities are communities of diversity. Each individual
within that community has multiple characteristics and possibly multiple
cultures with which they identify and that shape their specific
experience within that community.

Appreciating and understanding diversity, cultural sensitivity, and
culturally appropriate prevention programming for individuals and
communities is an ongoing and ever-changing process that requires
continual effort and patience.

The study of culture and diversity allows us to explore both
similarities and differences within a community. This is not about
learning the "right" facts about certain groups. Even though we may
identify specific groups within a community, it is likely that there are
many differences among members of the identified group. The goal is to
learn how to continually build our ability to learn about and use
similarities and differences as assets in prevention work.

### INFORMATION SHEET {#information-sheet-3 .HeadInfSheet}

# Values of Dominant U.S. Culture

Within any society, values people hold are likely to vary according to
many factors, including age, sex, ethnicity, religion, race, and social
class. However, every society has a set of core values and beliefs that
surround and contain the members of that society and that are upheld by
the members of that society who hold the most resources and privilege.
But the values that dominate a society can also contain contradictions.

Prevention efforts in the United States are framed by the larger context
of the values of the dominant U.S. culture. The communities with which
we work receive many different messages about substance use and abuse
from these values, some of them conflicting. To examine these
contradictions, it is important to take a look at dominant U.S. values
and the ways in which they both encourage and discourage substance use
and abuse. Through multiple studies over many years, social scientists
have found that there is a core set of values present in the dominant
U.S. culture. The values listed below act as standards by which American
social institutions, media, and others define what is desirable or
undesirable, good or bad, beautiful or ugly (Macionis, 1991).

-   Individualism

-   Activity and work

-   Material comfort

-   Science

-   Achievement and success

-   Freedom

-   Group superiority

-   Equal opportunity

-   Progress

-   Practicality and efficiency

The U.S. way of life is based on the rights of the individual; the
political system hinges on the idea of free elections, with each person
expressing his or her views; and the economy is focused on meeting the
varied needs of selective, individual consumers. U.S. culture celebrates
the accomplishments of people who get the job done and who control their
own fate through activity and work. Activities that generate money and
create material comfort are highly valued, especially those that utilize
practicality and efficiency to do more with fewer resources. Americans
are confident that science can effectively address problems and improve
lives. There is a strong belief that each person receives achievement
and success through competition and personal merit. There is also a
belief that freedom is essential so that personal goals may be pursued
and that everyone should have an equal opportunity to get ahead. In
contradiction to the belief in freedom and equality, personal worth is
often also linked to social categories based on social class, race,
ethnicity, and sex. There is also a strong belief in progress and the
promise that the future will be better than the present (Macionis,
1991).

Macionis, John. (1991). *Sociology*. (3rd ed.) Prentice Hall.

### INFORMATION SHEET {#information-sheet-4 .HeadInfSheet}

# Our Records

All of the assumptions, beliefs, knowledge, and values that we have
acquired about substance use and abuse---from our families, our own
cultural groups, the dominant culture of our society, and our
profession---combine to create a "record" that constantly plays in our
head and influences our decisions and behavior as preventionists.

The important thing to remember about these records is that everyone has
them---they can't be avoided, and simply having them does not make us
less valuable as individuals. However, it is our responsibility as we
work to become effective prevention practitioners to be aware of and
actively manage these records.

Many of us in helping professions have worked really hard to suppress
negative, discriminatory, or prejudiced attitudes we have heard or seen,
especially if they concern the clients or communities with which we
work. Sometimes, however, it is important to take a closer look at these
records to improve our ability to manage them effectively.

Records

-   are acquired from many sources,

-   influence behavior and decision making, and

-   are unavoidable, BUT

-   are manageable.

To manage records, we must

-   commit to the hard and ongoing work of embracing diversity,

-   examine the specific personal experiences that create undesirable
    records,

-   work to have as many positive experiences as possible with as wide a
    variety of people as possible,

-   listen to other people's stories about how others' records have
    affected them,

-   seek out skills that will improve our communication with different
    groups of people,

-   work to build bridges and create allies rather than feel guilty for
    having certain records, and

-   assume nothing---ask questions instead.

### INFORMATION SHEET {#information-sheet-5 .HeadInfSheet}

# Adultism

Excerpts from Bell, J. (1995). "Understanding adultism: A key to
developing positive youth-adult relationships." Available at
<http://freechild.org/bell.htm>.

Most of us are youth workers because we care about young people.
Personally we want to both be effective and have good relationships with
young people. We are satisfied when things go well. We feel bad when our
relationships sour. Sometimes we scratch our heads in dismay when,
despite our best efforts and concern, we find ourselves in conflict with
young people we work with. We sense that some larger dynamics are at
work that we can't quite see.

To be successful in our work with young people, we must understand a
particular condition of youth: that young people are often mistreated
and disrespected simply because they are young. The word *adultism*
refers to behaviors and attitudes based on the assumption that adults
are better than young people and entitled to act upon young people
without their agreement. This mistreatment is reinforced by social
institutions, laws, customs, and attitudes.

## The Heart of It

The essence of adultism is disrespect of the young. Our society, for the
most part, considers young people to be less important than and inferior
to adults. It does not take young people seriously and does not include
them as decision makers in the broader life of their communities.

Adults have enormous importance in the lives of almost every young
person. This fact may make it difficult to understand adultism. Not
everything the adult world does in relation to young people is adultist.
It is certainly true that children and young people need love, guidance,
rules, discipline, teaching, role modeling, nurturance, and protection.
Childhood and adolescence are a steady series of developmental stages,
each of which has a different set of needs, issues, and difficulties.
For example, a 3-year-old needs a different amount of sleep than a
15-year-old, or what works to physically restrain a 7-year-old will not
work with an 18-year-old, or how you explain conception and birth to an
inquisitive toddler will be quite different from how you explain these
to a sexually active teenager.

The point is that no one act or policy or custom or belief is in itself
necessarily adultist. Something can be labeled adultist if it involves a
*consistent* pattern of disrespect and mistreatment.

Certainly disrespect and mistreatment do not stem from adultism alone.
Other factors, like sexism, racism, poverty, physical or mental
disability, and so on, may also contribute to these results. But
systematic disrespect and mistreatment over years simply because of
one's young age are major sources of trouble.

Other "isms" like racism and sexism are well established and accepted as
realities. They each have a huge body of literature and research
documenting the effects and history of the oppression. There are novels,
movies, media presentations, political organizations, and social
movements devoted to illuminating and eliminating the "ism." Although
there is certainly much research and literature on children and youth,
very little of it concludes that young people are an oppressed group in
our society, with parallels to other such groups. Yet, there is abundant
evidence that points to the reality of adultism.

There are numerous examples of disrespect toward young people. Of
course, there is the obvious oppressive treatment: physical and sexual
abuse of young people. Official reports of child abuse reached 2.7
million cases in 1993. There is also a whole range of nonphysical
punishments or threats: being routinely criticized, yelled at,
invalidated, insulted, intimidated, or made to feel guilty, with the
effect of undermining a child's self-respect. If young people protest
against their mistreatment, they are often subjected to more punishment.
Young people are denied control and often even influence over most of
the decisions that affect their bodies, their space, and their
possessions. For example, most adults seem to think they can pick up
little children or kiss them or pull their cheeks or touch their hair
without asking.

Most young people know that in a disagreement with an adult, their word
will not be taken over the adult's. Most adults talk down to children,
as if children could not understand them. Adults often talk about a
young person with the young person present as if he or she were not
there. 

Adolescent young people are frequently followed by security guards in
stores, passed over by clerks who serve adults in line behind them,
chased by police from parks or gathering places for no good reason, or
assumed by passing adults to "be up to no good." The media often promote
negative images and stereotypes of them, especially of urban youth and
black youth.

An institutional example is the absence of socially responsible,
productive, and connected roles for young people in most societies.
Certainly in the United States, young people find few jobs, no real
policy-making roles, no positions of political power, and no high
expectations of young people's contributions to society. On the other
hand, the youth market is exploited for profit, as the manufacturing and
entertainment industries manipulate styles, fads, popularity, and all
other aspects of mass culture.

## The Emotional Legacy 

They say that the emotional legacy of years of this kind of treatment is
a heavy load, which can include any or all of the following: anger,
feelings of powerlessness, insecurity, depression, lack of
self-confidence, lack of self-respect, hopelessness, and feeling unloved
and unwanted.

What are some possible results of such feelings on young people's
behavior, especially as they reach adolescence and early adulthood?

-   Some act "out" by bullying, being prone to violence, rebelling
    against the "norm," leaving home early, and so on.

-   Some act "in" by becoming self-destructive: suicide, alcohol and
    drug abuse, depression, and so on.

-   Some gain a sense of belonging or safety by joining a gang, a
    clique, a club, or teams.

-   Some isolate themselves, become lonely, don't ask for help, don't
    have any close relationships, and don't trust others.

Again, adultism is not the only source of such behaviors, but it surely
plays a major role.

## A Link to Other Forms of Oppression

There is another important reason for understanding and challenging
adultism. The various ways we have been disrespected and mistreated
have, over time, robbed us of huge amounts of our human power, access to
our feelings, confidence in our thinking and ability to act, and
enjoyment of living. The pain we experience as young people helps
condition us to play one of two roles as we get older: to accept further
mistreatment as women, as people of color, as workers, etc., or to flip
to the other side of the relationship and act in oppressive ways toward
others who are in relatively less powerful positions than ours.

A simple illustration might help make this clear. Picture this: a sixth
grader is humiliated by the teacher in front of the class for not doing
the math problem at the board correctly. The recess bell rings. He is
fuming. He feels disrespected. He goes outside and picks on someone to
get his feelings out. Whom does he pick on? Someone smaller and often
someone younger. And so it goes: the sixth grader picks on the fifth
grader. The fifth grader turns and knocks down the third grader. The
third grader hits the first grader. The first grader goes home and picks
on his little sister. The little sister turns and kicks the cat.

We can observe in a group of children how mistreatment is passed down
among them. It is passed down the line of physical power---bigger to
smaller and often older to younger.

The significance of this early experience becomes clearer when it is
generalized to other forms of the abuse of power. Men, for example, who
were routinely beaten as little boys grow up to be wife beaters. This is
a clinical truism. Similarly, white people, disrespected as children,
turn the same attitude, embellished with misinformation, on people of
color.

This is one of the pervasive and lasting effects of the mistreatment of
young people. Bullies have been bullied. Abusers have been abused.
People who have been put down put others down. If a person had not been
disrespected and mistreated over and over as a child and young person,
that person would not willingly accept being treated that way as he got
older, nor would he willingly heap disrespect on others.

Adultism, racism, sexism, and other "isms" all reinforce each other. The
particular ways young people are treated or mistreated are inseparable
from their class, gender, or ethnic background. However, the phenomenon
of being disrespected simply because of being young holds true across
diverse backgrounds.

Adultism is a pervasive and difficult form of mistreatment to identify,
challenge, and eliminate precisely because every human being has
experienced adultism, whatever the degree of severity or cultural
variety, and because much adultism is considered natural and normal by
most people.

## Implications for Our Work With Young People

The set of behaviors, attitudes, policies, and practices that we have
labeled adultism gets in the way of more effective youth-adult
partnerships. It is useful to reflect on our interactions with young
people for signs of unintended disrespect in tone, content, or unspoken
assumptions. Those of us who work in youth programs must re-examine the
program practices, policies, and power relationships with the lens of
adultism and make adjustments.

A few general guidelines might improve our relationships with young
people:

-   Listen attentively to young people. Listen when they talk about
    their thoughts, experiences, and feelings about being young.

-   Ask questions. Ask what they think about everything.

-   Lie back. Curb the inclination to take over. Support the initiatives
    of young people.

-   Validate their thinking. Welcome their ideas.

-   Allow them to make mistakes. Putting their ideas into practice will
    bring mixed results. They will learn. We need to support the process
    of their taking leadership.

-   Change the power relationships wherever appropriate. Consider when
    adults can refrain from using authority, from making the final
    decision, from being the "real power" behind youth leadership.

-   At the same time, do not thrust young people into decision-making
    and leadership positions without training, practice, and
    understanding of their responsibilities. Otherwise, we set them up
    for frustration, confusion, possible failure, and humiliation.

-   Always respect all young people, no matter what their ages, and
    expect them to respect each other, at all ages. This is the starting
    point for reversing the internalized disrespect.

-   Have high expectations of their potential, and positively assess
    their current abilities. Never sell them short and always be
    prepared to lend a hand with a difficulty.

-   Do not take out your anger about them on them. They get this from
    adults all the time. It only adds more hurt. We need to take care of
    our upsets about them some other way.

-   Give young people accurate information about the way the world
    works, our experiences, relationships and sex, the contributions of
    young people to humankind, and other issues that interest them.
    Never lie to them.

-   Be patient with yourself when you unconsciously slip into old
    adultist habits. It will take time to undo them. Always appreciate
    how well you are doing.

## Good Policy

In our efforts to create solid relationships with young people, we
inevitably come up against adultism: theirs, ours, or society's. Program
staff in youth programs need to avoid two extremes.

One is the permissive attitude that says, "Anything the young people
want is OK." The mistreatment of and disrespect for young people have
left them, to varying degrees, with irrational feelings, misinformation,
and tendencies to act out their hurts. Adult staff must not abdicate
their responsibility to provide effective leadership and good policy.

The other extreme is for the adult authority to run the show. Adults,
likewise, have their share of irrationality, which is often the legacy
of the adultism visited upon them as youth. The young people need
policies that protect them from adultist leadership.

## Envisioning a World Without Adultism: A Final Comment

It is inspiring and sobering to ask young people to imagine a world in
which they were completely respected and never suffered from
mistreatment because they were young: Inspiring because they talk about
how education would be more related to them as learners, how they would
help hire teachers and develop curricula, how they would use schools as
community centers to provide services and opportunities for others, how
they would treat their siblings and friends with much more care, how
they would feel smart and effective, how they would feel part of their
community, how they would help decide how things got done, how they
would have numerous open and trusting relationships with adult family
members and others, how they would feel confident and loved, how they
would help end conflict between racial and cultural groups, how they
would be leaders. Sobering because present reality is so far from that.
However, each of us, in our individual relationships with young people
and in our programs, can help create the conditions that help young
people develop their vision, practice decision making, exercise
judgment, and grow in leadership.

### INFORMATION SHEET {#information-sheet-6 .HeadInfSheet}

# Requirements of a Culturally Effective Prevention Professional

1.  Recognize the influence of your own social position, values,
    perceptions, opinions, and knowledge on your interactions with
    others.

2.  Provide and promote an atmosphere in which similarities and
    differences can be explored and understand that this process is not
    only cognitive, but attitudinal and affective, as well.

3.  Draw upon the experiences of members to include diverse perspectives
    in any given curriculum, practice, or program.

4.  Encourage and accommodate a variety of learning and participation
    styles, building on community members' strengths.

5.  Be skeptical about the validity of diagnostic tools applied to
    people who are culturally different from those on whom the norms
    were calculated.

6.  Understand, believe, and convey that there are no culturally
    deprived or culturally neutral individuals or groups and that all
    cultures have their own integrity, validity, and coherence and
    deserve respect.

7.  Learn to embrace new, ambiguous, and unpredictable situations and be
    persistent in keeping communication lines open when
    misunderstandings arise.

8.  Help expand other people's knowledge of your own culture and affirm
    and legitimize other people's cultural perspectives.

9.  Encourage community members to see themselves in a multicultural
    perspective, and encourage skill building in cross-cultural
    communication and interaction.

10. Learn to be an ally to groups that experience prejudice and
    discrimination in your community. Help others learn to be an ally to
    your own group.

### INFORMATION SHEET {#information-sheet-7 .HeadInfSheet}

# Building Culturally Effective Prevention Programs

Cultural competency is at the center of the strategic prevention
framework (SPF). The Substance Abuse and Mental Health Services
Administration's (SAMHSA's) Generic Logic Model: Cultural Competence in
Proficient Prevention Service Delivery lists five stages of the SPF as
they relate to cultural competency: (1) formulate culturally-based
assumptions of change; (2) build collaborations; (3) select
"best-practice," "evidence-based" components; (4) document, review, and
improve the quality of program implementation; and (5) adapt and revise
"best-practice," "evidence-based" components (SAMHSA, 2005).

The following is a list of dimensions to consider in each stage of
prevention program development. Many of these dimensions can be
considered in more than one stage of the SPF.

## Assessment

-   Community priorities: Consider differences in opinion both within
    and between communities about the nature of the problems, including
    substance abuse, in the community. Other problems may be perceived
    as more serious than substance abuse.

-   Views of substance use, misuse, and abuse: Consider differences in
    opinion both within and between communities about the risks,
    benefits, acceptability, and social sanctions related to substance
    use and abuse.

-   Experience with prejudice and discrimination: Consider both past and
    current experiences by individuals, families, and communities and
    the costs associated with and coping mechanisms developed in
    response to these experiences.

## Capacity Building

-   Views of wellness and keepers of wellness: Consider community use of
    both alternative and traditional healing practices.

-   Historical circumstances: Consider personal, familial, and community
    histories, especially as they relate to inter- and intra-group
    interactions and access or lack of access to resources,
    institutions, power, and authority.

-   Organizational leadership: Consider whether board and other agency
    leadership are willing to invest both time and resources in building
    the capacity of the staff to work effectively with diverse
    populations. Does the board have a policy on nondiscrimination that
    it effectively communicates to all staff?

## Strategic Planning

-   Problem-solving strategy styles (hierarchical versus participatory):
    Consider differences in structures used for defining authority and
    making decisions in the family or community and whether the
    organization has an effective plan for the involvement of all
    segments of the community at multiple levels of the organization.

-   Service-provider expectations: Consider the presence or absence of
    high expectations and positive attitudes by the program staff,
    administrators, and board members toward all clients, regardless of
    their culture or group membership.

-   Organizational culture: Consider whether staff hiring and promotion
    practices, program publications, volunteer policies, and board
    member recruitment reflect a commitment to diversity.

## Implementation

-   Scheduling and timing: Consider strategies for expanding or
    condensing the format in which information is provided. Consider
    community expectations around timelines, deadlines, and punctuality.

-   Materials: Consider community-accepted meanings attached to symbols,
    numbers, colors, directional orientation, and other components
    related to the development of materials and visual aids and whether
    materials reflect the experiences, needs, and perspectives of the
    groups being served.

-   Teaching style: Consider whether the teaching styles used by
    facilitators match the learning styles of the participants.

-   Language and terminology: Consider the multiple meanings associated
    with words and terms and the potential for loss of meaning when
    slang, jokes, and analogies are translated or used out of their
    cultural context and whether the organization (board, facilitators,
    evaluators, etc.) shows respect for the participants' first language
    and dialects.

## Evaluation

-   Evaluation: Consider whether the assessment and evaluation
    procedures used in the program are culturally relevant.

-   Written, oral, and demonstrative communication styles: Consider
    different strategies for gathering, recording, interpreting, and
    reporting information; for asking questions; for giving negative
    responses; and for self-reporting. Also, consider whether the
    materials used in program events and publications reflect the
    diversity of the community or client base.

-   Views of prevention, health, and illness: Consider
    community-accepted definitions of health and sickness.

Gonzalez, V.M., Gonzalez, J.T., Freeman, V., & Howard-Pitney, B. (1991)
Health Promotion in Diverse Cultural Communities: Practical guidelines
for working in and with diverse cultural communities. Health Promotion
Resource Center, Stanford Center for Research in Disease Prevention in
cooperation with the Henry J. Kaiser Family Foundation.

Substance Abuse and Mental Health Services Administration. (2005).
*Generic logic model: Cultural competence in proficient prevention
service delivery.* Rockville, MD: U.S. Department of Health and Human
Services, Substance Abuse and Mental Health Services Administration.

### INFORMATION SHEET {#information-sheet-8 .HeadInfSheet}

# Where to Go to Find Information About Communities

## Start by Consulting the Experts

You will want to consult experts who know the community best and can
provide you with a valuable perspective on the community.

1.  **Individuals and groups from the focus community:** These people
    will often be your first contacts in the community. Through them you
    will learn more about the community in a more direct way than just
    by reading or hearing about it. These people can also work with you
    as partners and consultants to create or adapt the program to the
    various groups within the community. However, seek out community
    contacts carefully and be cautious of people who claim to be
    "experts" and to speak for a whole group of people. Look for leaders
    of community institutions like religious congregations, civil rights
    groups, and arts organizations. Poorly or hastily selected people
    can cost you the accuracy of your information, as well as the trust
    of the community in later program-building efforts.

2.  **Helping professionals or other persons working in similar
    communities or with similar problems:** These people may be found in
    local, regional, or national organizations (e.g., major minority
    health organizations or voluntary health agencies). These
    organizations often have accumulated relevant information based on
    their experience with various diverse communities throughout the
    country. Such people can provide you with more specific information
    about the problem as it is experienced by the different cultural
    groups. People in local organizations can also give you pointers on
    how to work in and with the community, sharing with you some of
    their own experiences (i.e., what is appropriate, what does or
    doesn't work well, and whom you might contact in the community to
    begin your planning).

3.  **Academicians:** These are the people in academic research
    institutions or government agencies who have done research in your
    areas of interest or have personal, sociological, or historical
    knowledge and experience with specific ethnic or subcultural groups.
    They can help you interpret and clarify the findings from your
    library search or direct you to the most recent and relevant
    research.

## Library Search

Although you should spend most of your time in the community, it is
important to devote some time to library research so that your approach
in the community is an informed one. The following are the types of
literature you will want to review. Remember that most information from
these sources is likely to cover a much broader population than you
intend to work with; be prepared for significant local and regional
differences.

1.  **Census data, maps, and other government documents, reports, and
    statistics:** Such information identifies who and where the focus
    community is, as well as what problems and needs exist in comparison
    with the general population.

> **2. Medical and public health references, specifically
> epidemiological and health intervention articles related to the health
> problem(s) you want to address in a program:** These provide the
> latest information on the scope of the problem, on trends in different
> populations, and on previous approaches taken to mediate the problem.
> This type of information can give you ideas on how you might approach
> the problem in your focus community.
>
> **3. Behavioral and social science literature:** Review intercultural
> and ethnic studies literature because this often includes a collection
> of psychological, sociological, and anthropological references
> specific to **different** racial, ethnic, or cultural groups. Such
> information can be extremely useful in providing you with a general
> understanding of different cultures' values, beliefs, practices, and
> historical experiences in the United States.
>
> **4. Local newspapers:** Both the major dailies and smaller
> neighborhood newspapers, including the various ethnic or cultural
> publications, are a good source of information about a focus
> community. The local news **and** editorial sections often provide
> some specifics about a community's or group's controversies (i.e.,
> their most pressing issues, concerns, or problems). These newspapers
> also provide listings of current or upcoming community events. Such
> information not only gives you some insight into the social and
> political "climate" in that community but can also help you identify
> people, places, and events to visit when you begin exploring the
> community.

If you feel time is too short to gather this type of extensive
information, go back to the drawing board and reassess your timeline. It
will take you MUCH longer to repair the damage done by a negative first
impression or an ineffective or offensive program than it will to do
your homework before you begin.

Gonzalez, V.M., Gonzalez, J.T., Freeman, V., & Howard-Pitney, B. (1991)
Health Promotion in Diverse Cultural Communities: Practical guidelines
for working in and with diverse cultural communities. Health Promotion
Resource Center, Stanford Center for Research in Disease Prevention in
cooperation with the Henry J. Kaiser Family Foundation.

### INFORMATION SHEET {#information-sheet-9 .HeadInfSheet}

# Assess Your Own Organization

The first step in the process toward developing a more culturally
effective prevention program (a step that is important but often
forgotten) is assessing your own organization.

## 1. Organizational diversity

-   Have members of your staff had experience working with diverse
    communities and with your focus population?

-   What is the range of cultural values, beliefs, and knowledge within
    your staff? How are they different from the focus community's?

-   How do these beliefs influence your staff's attitudes about
    different cultural groups?

-   Does your organization have policies and procedures that address
    diversity in management structure and program delivery?

## 2. Community interfacing

-   Does your organization collaborate with other community
    organizations? Are staff members involved in supportive
    relationships with other community groups?

-   Is your organization seen as a positive community partner with other
    community organizations and community members?

-   What opportunities have you created to empower community members and
    organizations to become involved in both leadership and support
    roles?

-   Is your organization and staff based in the community---or are you
    coming from the outside? If you are coming from the outside, how
    have you shown the community that you are the most appropriate
    organization to be leading this work?

## 3. Capacity for investment

-   Is your organization willing to commit the resources necessary to
    building or strengthening relationships with groups and communities?

-   Is your organization able and willing to utilize outside resources
    if the needed knowledge and abilities are not present in the
    organization?

## 4. Appropriateness of materials and process

-   Are audiovisual materials, public service announcements, training
    guides, print materials, evaluation instruments, and other materials
    to be used in the program linguistically appropriate for your focus
    community?

-   Are program processes culturally appropriate for your focus
    community?