U . 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 f o r S e r v i n 

D i v e r e C o m m u n it i 

 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

T b l e o f C o nt e 

Preface 2

Foreword 3

Acknowledgements 4

Introduction 6

Illustration: The Steps of Planning Services for Diverse Communities 7

P A R T I

Step 1: Assessments

Introduction to Step 1 8

Presentation 9

Diverse Community Questionnaire 12

Step 2: Identifying Resources About the Community

Introduction to Step 2 16

Presentation 17

Diverse Community Questionnaire 20

Step 3: Designing Services

Introduction to Step 3 24

Presentation 25

Diverse Community Questionnaire 28

Step 4: Program Evaluation

Introduction to Step 4 32

Presentation 33

Diverse Community Questionnaire 38

P A R T I I : A P P E N D I C E S

Appendix A: Diverse Community Questionnaire 42

Appendix B: Definitions 54

Appendix C: Diversity Concepts 56

Appendix D: Discussion Scenarios 58

Appendix E: Companion Presentations 66

Appendix F: Companion Exercises 104

Appendix G: List of Online Resources 108

Appendix H: Diversity Training Tips 128
2 U . 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 f c

G 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 use 

our own culture and values as a measuring 

stick to determine how and why we treat 

people the way we do. We frequently forget 

to ask ourselves, “How does this person want 

to be treated, not based on my values and 

culture, but theirs?” Or, “Do I even know their 

culture and values well enough to know if I’m 

treating them with respect?” These questions, 

which are the basis of ethical human 

interaction, are also at the core of providing 

quality service. 

Although it might not seem obvious that 

we should treat people the way they want 

to be treated and not the way individuals, 

institutions, or systems want to treat them, we 

can change how we view people of different 

cultures. Helping to facilitate this change is the 

purpose of this Toolkit.

This Toolkit is an invitation to make a cultural 

shift in your perspective: to learn, to grow, 

and to fully appreciate the people you have 

dedicated your career to serving. And you 

don’t have to do it alone. Making a cultural 

shift takes partnership and collaboration. 

This Toolkit supports the full participation of 

professionals, their agencies, and partners to 

work together to serve all diverse populations 

with respect, inclusiveness, and sensitivity.

* Bennett, M. J. 1998. “Overcoming the golden rule: Sympathy and empathy” in M. J Bennett 1998 Basic concepts of 

intercultural communication: Selected readings. Yarmouth, ME: Intercultural Press. 
 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

F o r e w o r

As the National Aging Services Network continues to meet the needs and expectations of 

increasingly culturally and ethnically varied populations, a better understanding of cultural 

differences and their relationship to the hallmarks of quality service—respect, inclusiveness, and 

sensitivity—becomes essential. Serving 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, AsianAmerican, American Indian, Hispanic, as well as older adults with disabilities, immigrant elders, 

and lesbian, gay, bisexual, and transgender (LGBT) older adults—begins with asking appropriate 

and timely questions.

This Toolkit provides Aging Agencies and their state and local partners with a starting point 

for conversations regarding how to better serve diverse populations of older adults. It is hoped 

that the dissemination and use of this Toolkit will enhance Older Americans Act services. 

Additionally, it is anticipated that this product will facilitate broader interest in developing other 

community-based tools and strategies that improve services for all populations and build the 

network’s value and expertise in advocating for and supporting older adult Americans, their 

families, and caregivers.

Kathy Greenlee

Assistant Secretary for Aging
4 U . S . A D M I N I S T R A T I O N O N A G I N G 

A k n o w l ed g e m e 

We would like to thank and acknowledge the following individuals for dedicating their 

time and energy to this project as reviewers. Treat others the way they want to be treated.

Greg Case

Aging Program Specialist

Office of Planning and Policy Development

U.S. Administration on Aging

U.S. Department of Health and Human Services

Carol Crecy

Director of Communications

Office of Communications

U.S. Administration on Aging

U.S. Department of Health and Human Services

Tina Howe

Web Content Manager

DB Consulting Group, Inc.

David A. Ishida

Regional Administrator, Regions IX & X

U.S. Administration on Aging

U.S. Department of Health and Human Services

Faith T. McCormick 

Acting Commissioner

Administration on Developmental Disabilities

Administration for Children and Families

U.S. Department of Health and Human Services

E. Percil Stanford, Ph.D.

Sr. Vice President and Chief Diversity Officer

Office of Diversity and Inclusion

AARP

Omar R. Valverde, Esq.

Office of Elder Rights

U.S. Administration on Aging

U.S. Department of Health and Human Services

Sherri Clark

Aging Services Program Specialist

Office of Communications

U.S. Administration on Aging

U.S. Department of Health and Human Services

Commander David A. Dietz

Senior Public Health Analyst

Office of Minority Health

Office of Public Health and Science

U.S. Department of Health and Human Services

Bernice Hutchinson

Diversity Policy Consultant

Darrick Lam, M.S.W.

Aging Services Program Specialist

U.S. Administration on Aging

U.S. Department of Health and Human Services

Anthony Sarmiento

Executive Director

Senior Service America, Inc.

Carmelita Tursi

Program Manager

Office of Diversity and Inclusion

AARP

Jose Velasco

Aging Services Program Specialist

Office of Regional Operations

U.S. Administration on Aging

U.S. Department of Health and Human Services

A special thanks to Leslie Swann, Ph.D., U.S. Administration on Aging, Program Specialist, for her dedication 

and energy in the conceptualization and development of this Toolkit.
 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

P r O 
6 U . S . A D M I N I S T R A T I O N O N A G I N G 

I nt r du ct i on A  T O O L KI T  FO R  S E R V I

D I V E R S E C O M M U N I T I E S

What is the Toolkit for Serving Diverse Communities?

The Toolkit consists of a four-step process and a 

questionnaire that assists the Aging Services Network 

and its partners with every stage of program planning, 

implementation, and delivery of diverse population 

services. The four steps are (1) Assessments, 

(2) Identifying Resources About the Community, 

(3) Designing Services, and (4) Program Evaluation. 

The Diverse Community Questionnaire provides 

questions to assist agency staff through each step of 

the process (see Appendix A). These questions enable 

agencies and their partners to consider how to improve 

services for diverse communities. 

What is the goal of the Toolkit? 

The goal of the Toolkit is to provide the Aging Network 

with a replicable and easy-to-use method for providing 

respectful, inclusive, and sensitive services for any 

diverse community. 

Who should use this Toolkit?

This Toolkit should be used by the Aging Network and 

its partners. This includes professionals who serve 

in a broad range of roles while assisting older adults 

and their families. Besides directors and managers 

of State Units on Aging (SUAs) and Area Agencies 

on Aging (AAAs), program managers, policy advisors, 

information specialists, outreach workers, options 

counselors, ombudsmen, and many others may find 

this Toolkit useful. 

How should the Toolkit be used?

The Toolkit should be used to help agencies and 

their partners to start a conversation on how to 

provide better services for diverse communities. That 

conversation begins with the Diverse Community 

Questionnaire that provides a series of questions to 

address which pieces may be missing from services. 

The questionnaire allows an agency and its partners to 

design service plans based on their own experiences 

and stages of learning in the process of serving diverse 

communities better.

What are the principles of the Toolkit?

1. Respect, inclusion, and sensitivity are the 

hallmarks of quality service. 

2. Delivering outreach and services based on the 

population’s values and perceptions is at the core 

of successful service delivery.

3. Serving diverse populations is not a “one size 

fits all” process. It involves asking the right 

questions to help address the needs and 

concerns of any population.

4. The meaning of diversity goes beyond race and 

ethnicity. It includes individuals with disabilities; 

lesbian, gay, bisexual, and transgender (LGBT) 

older adults; homeless seniors; older adult 

immigrants; and many other populations.

5. Diversity is all around us. It is a part of daily life 

and offers us opportunities to grow and learn 

about others.
 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 7

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 S 

F O R D I V E R S E C O M M U N I T I E S

S T E P 1 : Assessments

•	 Organizational assessment: policies, 

procedures, bylaws, and community 

perceptions

•	 Staff assessment: knowledge, skills, 

and practices

•	 Self-assessment: personal attitudes, 

beliefs, and behaviors

S T E P 2 : Identifying Resources 

 About the Community

•	 Agency knowledge of the service 

community

•	 Partnerships and coalitions with 

representatives from diverse groups

•	 Client and community data

•	 Client input

S T E P 3 : Designing Services

•	 Delivery of services through marketing 

and outreach

•	 Service recipients: clients, caregivers, and 

community organizations

•	 Types of services to be delivered

•	 Time and location of service delivery

•	 Barriers to service delivery and access

S T E P 4 : Program Evaluation

•	 Organization and client evaluation 

of services

•	 Lessons learned
8 U . S . A D M I N I S T R A T I O N O N A G I N G 

I nt r du ct 

S T E P 1 : A S S E S S M E N T S

Purpose

The purpose of this step is to encourage discussion 

of the significance of organizational, staff, and selfassessment concerning your agency’s readiness and 

capacity to serve diverse communities. 

Summary

This section explains Step 1 by providing brief 

questions, answers, and discussion points. This 

information can assist your agency and its partners 

with understanding the value of assessments that 

identify gaps in agency capacity and knowledge 

regarding diverse communities.

Core Learning Question

What types of experiences, resources, and knowledge 

do your agency and its partners have with providing 

services to diverse communities?

Supplemental Toolkit Resources for Step 1

To learn more about assessments, see:

Appendix G: List of Online Resources for Step 1 

Performing in-depth assessments is the first step 

in serving diverse populations. It is critical for 

your agency to understand what types of skills 

and knowledge you have and what types of skills 

and knowledge you will need to add to serve a 

community with a diverse 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

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 G 

S 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 S

•	 Organizational assessment: policies, 

procedures, bylaws, and community 

perceptions

•	 Staff assessment: knowledge, skills, 

and practices

•	 Self-assessment: personal attitudes, 

beliefs, and behaviors

S T E P 1 : Assessments

S T E P 2 : Identifying Resources 

About the Community

S T E P 4 : Program Evaluation S T E P 3 : Designing Services

Assessments should be provided at every 

agency level.

Your agency can conduct its own assessments. However, 

some experts recommend that a third-party consultant 

conduct assessments. A consultant can ensure objectivity 

and 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?
1 0 U . S . A D M I N I S T R A T I O N O N A G I N G 

O R G A N I Z A T I O N A L 

A S S E S S M E N T

Who? 

The agency.

Why? 

Provides a process to assess the policies, procedures, 

mission statements, and community perceptions of an 

agency.

Value? 

Helps design a formal plan to assess, review, and 

revise policies and procedures to make them culturally 

responsive for the agency’s service populations. It also 

helps align policy with practice.

It is not enough to simply train staff members 

without considering how policies directly impact 

the service delivery needs of diverse communities. 

Organizational assessments can help your agency 

understand how policies, procedures, and mission 

statements 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 T

Who? 

All staff, managers, board members, committee 

members, consumer boards, and volunteers—anyone 

who influences policy and provides services.

Why? 

Provides a process to assess the knowledge, skills, and 

practices of staff and helps identify gaps in knowledge 

and practice.

Value? 

Helps design a formal plan to establish goals and set 

milestones for staff education. Provides an opportunity 

for open dialog regarding staff attitudes about serving 

diverse communities.

Staff assessments help your agency understand 

gaps in collective staff knowledge. 

Staff assessments can be used as tools to 

provide a comprehensive picture of your 

agency’s skills and assets in serving 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 E L F - A S S E S S M E N T 

Who? 

All staff, managers, board members, committee 

members, consumer boards, and volunteers—anyone 

who influences policy and provides services.

Why? 

Provides a confidential process for an individual 

to assess personal attitudes, behaviors, and beliefs 

connected with serving diverse communities. 

Value? 

Helps establish personal milestones for gaining 

knowledge and acquiring a level of comfort with 

serving diverse communities.

Self-assessments provide a confidential, individual 

measurement of a person’s comfort with 

interacting with members of diverse communities.
1 2 U . S . A D M I N I S T R A T I O N O N A G I N G 

D i v e r e C o m m u n it

Q u e t i o n a i 

S T E P 1 : A S S E S S M E N T S

The Diverse Community Questionnaire is a tool that allows your agency, its partners, and stakeholders to have a 

conversation about what respectful, inclusive, and sensitive services are to a particular community. We encourage 

your agency to use this tool with flexibility, and tailor this questionnaire to meet the particular needs of the 

communities it serves.

Target Population:

____________________________________________

____________________________________________

What is the service population’s 

neighborhood/community location?

____________________________________________

____________________________________________

Organizational, staff, and self-assessments allow an 

agency to understand its collective experience and 

knowledge about a particular community. Whether 

your agency wants to improve its services for a 

specific group or wants to establish a visible and 

trusted presence in a neighborhood, the questions 

below help your agency understand how assessments 

provide a comprehensive snapshot of your ability to 

provide services for that 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 1 3

Has your agency provided services to this community? 

Yes No 

If yes, did your agency include this community’s 

perspectives in its planning of program mission 

statements, policies, and procedures? 

If no, what steps does your agency plan to take to 

include this community in its planning of program 

mission statements, policies, and procedures (e.g., 

consumer advisory boards, community advisory 

councils, advocacy groups)?

__________________________________________________________________________

__________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

If your agency has served or currently serves this 

community, what did it learn about the community 

that could be helpful in providing better services?

__________________________________________________________________________

__________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

If your agency has served or currently serves this 

community, what feedback has it received about this 

community’s perspectives of your services?

__________________________________________________________________________

__________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

How can your agency improve or enhance this 

perspective?

__________________________________________________________________________

__________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Are any of your agency’s staff, board members, 

committee members, and/or consumer advisory-board 

members from this community?

Yes No 

If yes, what knowledge and skills do they have that can 

help your agency better serve this population?

__________________________________________________________________________

__________________________________________________________________________

___________________________________________________________________________
1 4 U . S . A D M I N I S T R A T I O N O N A G I N G 

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

If no, what steps does your agency plan to take to 

provide representation from this community while 

offering services to its older adult population?

__________________________________________________________________________

__________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Have any of your staff had experience serving this 

population, either with your agency or with other 

agencies? Yes No

If yes, what knowledge and skills did they gain to help 

your agency provide better services to this population 

(e.g., bilingual skills, established relationships with 

trusted community organizations, knowledge of 

neighborhood advisory board members)?

__________________________________________________________________________

__________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

How do individual staff members characterize this 

community (e.g., difficult to serve, informal caregiving 

network)? 

__________________________________________________________________________

__________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

What is this characterization based on (e.g., data, 

feedback from individuals outside of the population’s 

community, feedback from individuals within the 

population’s community, service providers, staff 

observation)?

__________________________________________________________________________

__________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________
 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

Additional Notes:

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1 6 U . 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 2 : I D E N T I F Y I N G 

R E S O U R C E S A B O U T 

T H E C O M M U N I T Y

I nt r du ct 

Purpose

The purpose of this step is to foster discussion on 

identifying resources that can help your agency find 

reliable information on diverse communities.

Summary

This section explains Step 2 by providing brief 

questions, answers, and discussion points. This 

information can help your agency identify a variety of 

reliable and factual resources about the characteristics 

of a particular community. 

Core Learning Question

What resources can assist your agency with gaining 

knowledge about a particular community?

Supplemental Toolkit Resources for Step 2

To learn more about identifying resources, see:

Appendix E: Companion Presentations

• Factors that Influence Culture

• World View

Appendix G: List of Online Resources for Step 2

Part of providing quality services is finding out 

as much information as your agency can about a 

particular diverse community.

Understanding the community’s needs and values 

can help your agency develop more appropriate 

and valuable 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

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 G 

S 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 S

S T E P 1 : Assessments

S T E P 2 : Identifying Resources 

 About the Community

•	 Agency knowledge of the service 

community

•	 Partnerships and coalitions with 

representatives from diverse groups

•	 Client and community data

•	 Client input

• S T E P 4 : Program Evaluation • S T E P 3 : Designing Services

Identifying 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?
1 8 U . S . A D M I N I S T R A T I O N O N A G I N G 

A G E N C Y K N O W L E D G E O F T H E 

S E R V I C E C O M M U N I T Y 

Who? 

All staff, board members, committee members, 

partnering agencies, and volunteers.

Why? 

Ensures that an agency understands the community 

it is serving.

Value? 

The agency’s staff can find out the values of 

the community to tailor its services to meet the 

community’s needs.

Your agency and its staff can gain knowledge about 

a service population by reviewing assessments to 

find out what types of experiences you already have 

with a particular community. Also look to your board 

members, volunteers, and partners that work in the 

client’s community for their levels of expertise.

Managers should track staff’s previous and current 

experiences in working with diverse communities. 

Some types of relevant knowledge and skills, such 

as knowledge of trusted community organizations 

or bilingualism, can be invaluable and provide 

opportunities for cultural brokering and peer-topeer training. 

P A R T N E R S H I P S A N D C O A L I T I O N S 

W I T H R E P R E S E N T A T I V E S 

F R O M D I V E R S E G R O U P S

Who? 

Trusted and valued representatives from diverse 

service areas. 

Why? 

Creates an opportunity to gain credibility through 

association with individuals and groups the diverse 

community trusts.

Value?

Provides an authentic opportunity for learning: crosstraining, consulting, and providing collaborative services.

Build partnerships effectively by learning the art of 

the “hand-shake meeting.”

•	 Let the potential partner know you have an 

authentic interest in serving the community.

•	 Have something to offer. If the potential partner 

is valuable to your agency, then how can your 

agency be of value to the potential partner?

•	 Focus on commonalities: “We all want to work 

together to serve this community.”

Partners can play key roles in helping your agency 

learn about a community:

•	 Cross trainings

•	 Collocation of services 

•	 Seminars, webinars, teleconferences, brown bag 

lunch exchanges

•	 Site visits (physical and virtual)
 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

Make sure the service community trusts these partners by understanding the difference between those who are 

perceived as trusted inside a service population’s community versus those merely perceived as trusted from outside 

of the community.

C L I E N T D A T A

Who? 

Aging agencies, research partners, local colleges 

and universities, research firms, and local, state, 

and Federal agencies.

Why?

Determines the best types of services for a 

particular community.

Value?

Increases understanding of the types of services 

to administer that can save time and energy by 

avoiding costly mistakes.

In addition to trusted community groups, these 

organizations may also be helpful in identifying 

sources of information on diverse communities:

•	 Colleges and universities

•	 Research firms

•	 Local, state, and Federal agencies

Websites, fact sheets, email lists, and newsletters 

are all valuable resources that can help your 

agency and its staff obtain the latest information on 

data and trends.

C L I E N T I N P U T

Who?

Older adults, their families, and caregivers who will 

receive the services.

Why?

Reveals how consumer expectations and values 

relate to service provision.

Value?

Understanding what types of services diverse 

communities value and delivering those services 

can enhance and improve an agency’s reputation 

and trustworthiness within a community.

Client input can provide a realistic snapshot of the 

service population’s needs and expectations.

Client input can come from consumer advisory 

boards, focus groups, surveys, interviews, case 

studies, and other sources. 
2 0 U . 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 2 : I D E N T I F Y I N G R E S O U R C E S 

A B O U T T H E C O M M U N I T Y

D i v e r e C o m m u n it

Q u e t i o n a i 

The Diverse Community Questionnaire is a tool that allows your agency, its partners, and stakeholders to have a 

conversation about what respectful, inclusive, and sensitive services are to a particular community. We encourage 

your agency to use this tool with flexibility, and tailor this questionnaire to meet the particular needs of the 

communities it serves.

Target Population:

____________________________________________

____________________________________________

What is the service population’s 

neighborhood/community location?

____________________________________________

____________________________________________

Knowing where to find accurate information about 

a service community is invaluable when planning 

service delivery. The questions in Step 2 assist your 

agency with identifying resources, (such as data, 

research, and studies) that help it understand the 

characteristics of the service population (such as 

family structure, community resources, and health 

disparities). Understanding the characteristics of a 

service population prepares your agency for Step 3, 

Designing 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 2 1

Which resources does your agency’s staff use to obtain 

current information and training on providing services 

to this population? 

__________________________________________________________________________

__________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Has your agency offered staff opportunities to learn 

about this particular population? Yes No

If yes, please describe how these learning opportunities 

can help your agency provide better services to this 

population.

__________________________________________________________________________

__________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Can staff identify additional training or technical 

assistance that would be helpful in serving this 

population?

__________________________________________________________________________

__________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Which organizations, including current partners, 

can assist your agency and staff with learning how 

best to serve this population? (As you think about 

these organizations, consider whether or not they are 

organizations that are visible, respected, and trusted by 

the community your agency serves.)

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

____________________________________________________________________________

What do national, state, and local data reveal about 

the needs of this community (e.g., education, income, 

living arrangements)? 

U.S. Census Bureau: www.census.gov 

AoA Aging Statistics: www.aoa.gov/AoARoot/Aging_

Statistics/index.aspx

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

____________________________________________________________________________
2 2 U . S . A D M I N I S T R A T I O N O N A G I N G 

What do disease and illness (morbidity) data reveal 

about the needs of this population? 

AoA statistics: www.aoa.gov/AoARoot/Aging_

Statistics/index.aspx

AHRQ National Healthcare Quality & Disparities 

Reports: www.ahrq.gov/qual/qrdr08.htm 

CDC National Health Statistics home page:

www.cdc.gov/nchs

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Based on state and community level data and 

community partners, how would your agency 

characterize the following? These answers might 

change as your agency gets more information 

from partners and verifies this information with the 

community.

a. Community-based supports

(e.g., family, church, grassroots organizations)

 Good Fair Poor

 

b. Social service resources 

 Good Fair Poor

c. Environmental conditions

(e.g., pollution/air quality)

 Good Fair Poor

d. Public transportation

 Good Fair Poor

e. Economic stability 

 Good Fair Poor

f. Opportunities for community involvement

(e.g., socialization, volunteerism, clubs) 

 Good Fair Poor

 

How does this information (a – f) influence the types 

of services your agency provides for this population?

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

____________________________________________________________________________

Community’s most common family structure:

Nuclear Extended Other:

____________________________________________________

What are this community’s religious/spiritual beliefs 

and practices?

_______________________________________________________________________________

______________________________________________________________________________

_______________________________________________________________________________

______________________________________________________________________________
 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

How will these religious/spiritual beliefs and practices 

influence the services your agency provides?

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

____________________________________________________________________________

These answers might change as your agency gets more 

information from partners and verifies this information 

with the service population.

Check all that apply:

______ Decisions are made by the client.

______ Decisions are made by the client and family 

member(s) (adult children/spouse/partner).

______ Decisions are made by the group consensus 

of various loved ones.

______ Decisions are made by another (in the case 

of homelessness, mental health issues, 

guardianship).

______ Females are the primary caretakers in this 

community.

______ Males are the primary caretakers in this 

community. 

______ Adult children are the primary caretakers in 

this community.

______ Spouses/partners are the primary caretakers 

in this community.

______ Caretakers could be any loved one and/or 

individual in the community.

______ Another provides primary care (in the case 

of homelessness, mental health issues, 

guardianship).

What are the primary languages (including sign 

language) of this community?

____________________________________________________________________________________________

____________________________________________________________________________________________

__________________________________________________________________________________________

Is this population historically an immigrant 

community? Yes No

If yes, how will the issue of immigration influence 

the types of services your agency provides (e.g., legal 

services, housing, employment?

____________________________________________________________________________________________

____________________________________________________________________________________________

__________________________________________________________________________________________

What are your agency’s plans to ensure that client 

input is used in the planning of services and their 

delivery (e.g., focus groups, interviews, consumer 

advisory boards, surveys)?

______________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________
2 4 U . 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 3 : D E S I G N I N G 

 S E R V I C E S

I nt r du ct 

Purpose

The purpose of this step is to facilitate discussion 

about issues that should be considered when planning 

services for diverse communities.

Summary

This section explains Step 3 by providing questions, 

answers, and discussion points. This information can 

help your agency consider what kinds and types of 

services are appropriate for a particular group.

Core Learning Question

How should your agency design respectful, inclusive, 

and sensitive services for this specific community?

Supplemental Toolkit Resources for Step 3

For more information on designing services, see:

Appendix D: Discussion Scenarios

Appendix E: Companion Presentations

• Acculturation

• Barriers to Serving Diverse Communities

 

Appendix F: Companion Exercises

• Technical or Operational Knowledge

• Structural or Cultural Barriers to 

Accessing Services

Appendix G: List of Online Resources for Step 3

Using the information your agency has gathered 

in Steps 1 and 2 of this process is critical when 

designing services for diverse communities.

•	 Your assessments help your agency identify 

experience and knowledge gaps.

•	 The resources you identify about the 

community can help fill these gaps. 
 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

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 G 

S 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 S

S T E P 1 : Assessments S T E P 2 : Identifying Resources

About the Community

S T E P 3 : Designing Services

•	 Delivery of services through marketing 

and outreach

•	 Service recipients: clients, caregivers, and 

community organizations

•	 Types of services to be delivered

•	 Time and location of service delivery

•	 Barriers to service delivery and access

• S T E P 4 : Program Evaluation

The topics covered in Step 3 help your agency design services based on the hallmarks of quality service: respect, 

inclusiveness, and sensitivity.
2 6 U . 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

How should services be designed and delivered 

to this population? 

Colors, language, images, pictures; with the assistance 

of family and/or life partners, caregivers, community 

organizations, etc. 

Who should receive your agency’s services? 

Clients, caregivers, community organizations, etc.

What types of services should be delivered, and which 

services are most valued and appreciated?

Caregiver support, meals, older adult activity centers, 

transportation, medication management, health 

education, etc.

When is service delivery the most valued? 

Social activities during holidays, meals at the end of 

the month, energy assistance during summer/winter 

months, etc.

All of these questions ensure that there is no “cultural 

misalignment of services.” This occurs when a specific 

community does not value the services provided and 

therefore does not use them.

For example, if a particular community values 

adult children as the primary caregivers for elder 

parents, sending a home health aide (a stranger) 

to care for an elder parent creates a cultural misalignment of services. Training and supporting 

adult children to better care for their parent aligns 

with the values of this particular community.

Include the perspective of the community when 

designing outreach materials and services. Your 

agency can use focus groups and consumer 

advisory boards to test the effectiveness of 

outreach materials.
 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

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 and 

social 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 for individuals with disabilities

• Environmental conditions/home setting

Think about non-traditional locations for 

providing services to better target your outreach.

Understanding barriers in the community can 

save valuable time and money and help shift 

resources to where they are most needed in 

a community.
2 8 U . S . A D M I N I S T R A T I O N O N A G I N G 

D i v e r e C o m m u n it

Q u e t i o n a i 

S T E P 3 : D E S I G N I N G S E R V I C E S

The Diverse Community Questionnaire is a tool that allows your agency, its partners, and stakeholders to have a 

conversation about what respectful, inclusive, and sensitive services are to a particular community. We encourage 

your agency to use this tool with flexibility, and tailor this questionnaire to meet the particular needs of the 

communities it serves.

Target Population:

____________________________________________

____________________________________________

What is the service population’s 

neighborhood/community location?

____________________________________________

____________________________________________

Designing services that are respectful, inclusive, 

and sensitive is the hallmark of quality service 

delivery. The questions below assist your agency 

with defining what quality service means to a 

particular community based on its characteristics, 

which were explored in Step 2.
 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 9

Based on the data your agency has collected about 

this service population, its community, and trusted 

organizations (e.g., churches, social clubs, grassroots 

nonprofit social services):

How should outreach and marketing materials 

be improved or implemented to better serve this 

population?

________________________________________________

________________________________________________

________________________________________________

________________________________________________

________________________________________________

________________________________________________

Do marketing/outreach materials show pictures of 

individuals from the community ? Yes No

Are marketing/outreach materials languageappropriate/bilingual? Yes No

Other marketing/outreach strategies:

________________________________________________

________________________________________________

________________________________________________

________________________________________________

________________________________________________

________________________________________________

Do marketing/outreach materials discuss public 

accessibility of services (e.g., building accessibility and 

which bus line, subway stop, transportation companies 

provide access to the service area)?

Yes No

If no, what steps does your agency plan to 

take to inform the service population of service 

accessibility?

________________________________________________

________________________________________________

________________________________________________

________________________________________________

________________________________________________

________________________________________________

How will marketing/outreach materials be pilot 

tested/reviewed, and by whom in the community 

(e.g., focus groups, interviews, surveys, consumer 

advisory board)?

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

____________________________________________________________________________

Do marketing/outreach materials indicate the 

availability of bilingual staff, including sign language 

interpreter(s)? Yes No
3 0 U . S . A D M I N I S T R A T I O N O N A G I N G 

Which group in this population’s community would 

benefit most from your agency’s services (e.g., clients, 

caregivers, community organizations)?

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

____________________________________________________________________________

Which services does your agency provide that would 

be 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 the 

community, in the home)?

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

____________________________________________________________________________

Which legal requirements (e.g., anti-discrimination 

laws, population targeting requirements, translation 

requirements) regarding service accessibility apply to 

services you provide to this population?

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

____________________________________________________________________________

Which steps does your agency plan to take to ensure 

that its policies, procedures, and services are aligned 

with legal requirements regarding service accessibility 

for this group (e.g., anti-discrimination laws, service 

population targeting requirements)?

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

____________________________________________________________________________

What are the structural barriers* that limit services 

for this group (e.g., transportation, childcare for 

grandchildren, health literacy/education, income)?

____________________________________________________

____________________________________________________

____________________________________________________

* Defined in Appendix B: Definitions
 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 1

Which steps does your agency plan to take to reduce 

or eliminate structural barriers to services for this 

population?

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

____________________________________________________________________________

What are the cultural barriers* that limit services 

to this group (e.g., stigma of accepting help, values 

concerning gender/family roles, religious/spiritual 

beliefs)?

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

____________________________________________________________________________

Which steps does your agency plan to take to reduce 

or eliminate cultural barriers* to services for this 

population? 

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Additional Notes:

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

____________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

____________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

____________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

* Defined in Appendix B: Definitions
3 2 U . 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 4 : P R O G R A M 

 E V A L U A T I O N

I nt r du ct 

Purpose

The purpose of this step is to promote discussion on 

the significance of program evaluation.

Summary

This section explains Step 4 by providing brief 

questions, answers, and discussion points. This 

information helps your agency consider which program 

evaluation methods and tools will best assess your 

agency’s effectiveness and client satisfaction.

Core Learning Question

What types of program evaluation methods are best 

suited to measure program effectiveness and client and 

community satisfaction?

Supplemental Toolkit Resources for Step 1

For resources and guidance on program evaluation, see:

Appendix G: List of Online Resources for Step 4

It is important to evaluate the quality, delivery, and 

performance of your program—from both your 

viewpoint and client and community perspectives.
 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

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 G 

S 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 S

S T E P 1 : Assessments S T E P 2 : Identifying Resources 

About the Community

S T E P 3 : Designing Services

S T E P 4 : Program Evaluation

•	 Organization and client evaluation 

of services

•	 Lessons learned

Program evaluation data helps your agency make the case that it is being true to its commitment and mission to serve 

all older adults.
3 4 U . S . A D M I N I S T R A T I O N O N A G I N G 

O R G A N I Z A T I O N A L A N D C L I E N T 

E V A L U A T I O N O F S E R V I C E S

What should be evaluated?

Services (provided by both the agency and its partners);

client and community perceptions of the quality and 

effectiveness of services.

Why?

Evaluates the process of service delivery and the 

quality of services.

How? 

Process evaluation.

Outcome evaluation.

Value?

Ensures that program process and outcomes align with 

the values and needs of the client and community.

The value of measuring both delivery and 

quality helps your agency evaluate whether its 

perceptions of its services are aligned with the 

perceptions of diverse clients and communities.

P R O C E S S E V A L U A T I O N

What?

Evaluates the way a program is implemented and how 

effectively it is being managed.

Depends on . . .

How well program components and activities are 

defined and identified.

Asks . . . 

“How does our agency manage the program to get 

things done?” and “Are we managing the program in 

the most effective way?” (continued on next page)

By appreciating how a program is implemented 

and managed, your agency can understand 

its program components and the way those 

components are being delivered and meeting 

diverse client and community needs.
 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

(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 N

What?

Determines the program’s effectiveness for its intended 

client and whether goals were met and desired outcomes 

were accomplished.

Depends on . . . 

How clearly program goals and objectives are defined.

Asks . . . 

“What were the program’s results?” and “Did we meet 

our goal?”

Value?

Helps to identify:

If the program is meeting its intended goals 

and objectives.

If services are meeting client expectations and reflect 

community values.

Unanticipated outcomes and/or effects that can be 

positive or negative.

Outcome evaluation allows your agency to go 

beyond output (counting the number of times 

an activity occurs) and begin to move toward 

measuring results and service quality. 

Outcome evaluation should include both 

qualitative (descriptive) and quantitative 

(numeric) data. Each can reveal something 

valuable about the service population.
3 6 U . S . A D M I N I S T R A T I O N O N A G I N G 

D A T A

What? 

Data is information that comes in two forms: 

Quantitative – in the form of numbers (statistical 

information)

Qualitative – in the form of words (descriptive 

information)

Data sources are all around us

Case management database, records and files, existing 

statistics, and input from clients and partners.

How do I collect the data? 

• Documenting and tracking activities 

• Database queries 

• Questionnaires and surveys

• Interviews

• Observation

• Focus groups

It’s important that primary source data (data 

from the original source—the client) is 

compared to secondary source data (sources 

other than the client). 

Comparing both data sources allows your 

agency to see inconsistencies in results. Asking 

clients to clarify any inconsistencies in the 

data can further support a robust analysis of 

evaluation 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/or 

outcomes) is needed. 

3. Choose the type of data collection method.

4. Choose the data source(s).

5. Select an evaluation team and define specific roles 

and tasks.

Your agency should think about cost and capacity:

•	 Does your agency include evaluation as a 

regular part of a program’s budget?

•	 Does your agency have supports and systems 

in place to manage evaluation easily? 
 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

Identify partners and agencies whose expertise your 

agency can leverage. 

Don’t forget to include client and community 

representation.

6. Make sure evaluation questions are aligned with:

The program goals, objectives, and/or outcomes you 

are measuring.

The program’s components and activities. 

The clients’ and community’s identified needs, 

expectations, and values.

7. Create data collection protocols and review data 

collection capacity.

Develop a guidance document for consistent 

data collection (i.e., everyone is collecting the same type 

of data and that data is clearly defined).

Check telephonic and case management system’s 

ability to capture the type and quality of data needed.

Good questions are at the core of a solid 

evaluation. Make sure your questions are aligned 

with specific program components, activities, 

goals, and results (which should 

have been defined at the beginning of your 

evaluation plan).

A good evaluation process is characterized 

by support.

•	 Does your evaluation team have agreed-upon 

guidelines to support the staff involved in the 

data collection process?

•	 Does your evaluation team have access to 

systems that make it easy to capture and 

collect data?

L E S S O N S L E A R N E D 

Who?

Everyone involved in the process, including the 

community.

Why?

Helps an agency identify how to make programs better 

for a particular diverse community.

Value?

Demonstrates that an agency is invested not only 

in its programs, but the community it serves.

Strengthens the community’s role as a stakeholder.

Your agency can use evaluation data to educate 

staff, advisory and other boards, partners, 

volunteers, and the service community on how to 

improve services—it’s a collaborative process.

When clients and their community are involved 

in program evaluation, it gives any agency the 

opportunity to empower stakeholders to share 

the responsibility for improving services.
3 8 U . S . A D M I N I S T R A T I O N O N A G I N G 

D i v e r e C o m m u n it

Q u e t i o n a i 

S T E P 4 : P R O G R A M E V A L U A T I O N

The Diverse Community Questionnaire is a tool that allows your agency, its partners, and stakeholders to have a 

conversation about what respectful, inclusive, and sensitive services are to a particular community. We encourage 

your agency to use this tool with flexibility, and tailor this questionnaire to meet the particular needs of the 

communities it serves.

Target Population:

____________________________________________

____________________________________________

What is the service population’s 

neighborhood/community location?

____________________________________________

____________________________________________

Program evaluation helps your agency make the 

case that it is being true to its commitment and 

mission to provide quality service to all older 

adults. The questions to follow allow your agency 

to consider how program evaluation can help it 

improve its 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 3 9

Is a program evaluation approach established for the 

services this community needs and values the most? 

Yes No

If yes, which resources has your agency identified that 

can help with evaluating services for this community?

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

If no, how does your agency plan to evaluate those 

services?

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

Which partners or potential partners can help your 

agency evaluate services for this community?

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

What is your agency’s plan for verifying evaluation 

results with partner, client, and community 

perceptions of your agency’s services (e.g., focus 

groups, interviews, surveys, questionnaires)?

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

Does your agency know the data collection barriers 

for this community (e.g., trust, confidentiality, previous 

negative experiences with research)?

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

What type of data collection methods align with 

the communication traditions of this community 

(oral tradition, written tradition, or both)? Should 

there be any special considerations made based on 

communication traditions?

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________
4 0 U . S . A D M I N I S T R A T I O N O N A G I N G 

Does your agency plan to collect quantitative 

(numeric) data, qualitative (descriptive) data, or both? 

Why or why not, and what does your agency think is 

best for this community?

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

Does your agency plan to use both output (counting 

the number of times or occurrences of an activity), as 

well as outcome (results) measures? Yes No

If 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 improve 

services for this community? What is the data’s value 

to your agency, its partners, and the community?

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

How does your agency plan to share or disseminate its 

evaluation data and lessons learned to empower the 

community to engage in better self-advocacy?

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________
 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 f o r S e r v i n 

D i v e r e C o m m u n it i 

P rt T w

A p e di 
4 2 U . S . A D M I N I S T R A T I O N O N A G I N G 

A p e d i x A D I V E R SE  C O M M U N I T

Q U E S T I O N N A I R E

The Diverse Community Questionnaire is a tool that 

allows your agency, its partners, and stakeholders to 

have a conversation about what respectful, inclusive, 

and sensitive services are to a particular community. 

We encourage your agency to use this tool with 

flexibility, and tailor this questionnaire to meet the 

particular needs of the communities it serves.

Target Population:

____________________________________________

____________________________________________

What is the service population’s 

neighborhood/community location?

____________________________________________

____________________________________________
 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

S T E P 1 : A S S E S S M E N T S

Organizational, staff, and self-assessments allow an 

agency to understand its collective experience and 

knowledge about a particular community. Whether 

your agency wants to improve its services for a specific 

group or wants to establish a visible and trusted 

presence in a neighborhood, the questions below help 

your agency understand how assessments provide 

a comprehensive snapshot of your ability to provide 

services for that community.

Has your agency provided services to this community? 

Yes No 

If yes, did your agency include this community’s 

perspectives in its planning of program mission 

statements, policies, and procedures? 

If no, what steps does your agency plan to take to 

include this community in its planning of program 

mission statements, policies, and procedures (e.g., 

consumer advisory boards, community advisory 

councils, advocacy groups)?

__________________________________________________________________________

__________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

If your agency has served or currently serves this 

community, what did it learn about the community 

that could be helpful in providing better services?

__________________________________________________________________________

__________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

If your agency has served or currently serves this 

community, what feedback has it received about this 

community’s perspectives of your services?

__________________________________________________________________________

__________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________
4 4 U . S . A D M I N I S T R A T I O N O N A G I N G 

How can your agency improve or enhance this 

perspective?

__________________________________________________________________________

__________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Are any of your agency’s staff, board members, 

committee members, and/or consumer advisory-board 

members from this community?

Yes No 

If yes, what knowledge and skills do they have that can 

help your agency better serve this population?

__________________________________________________________________________

__________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

If no, what steps does your agency plan to take to 

provide representation from this community while 

offering services to its older adult population?

__________________________________________________________________________

__________________________________________________________________________

___________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

Have any of your staff had experience serving this 

population, either with your agency or with other 

agencies? Yes No

If yes, what knowledge and skills did they gain to help 

your agency provide better services to this population 

(e.g., bilingual skills, established relationships with 

trusted community organizations, knowledge of 

neighborhood advisory board members)?

__________________________________________________________________________

__________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

How do individual staff members characterize this 

community (e.g., difficult to serve, informal caregiving 

network)? 

__________________________________________________________________________

__________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________
 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

What is this characterization based on (e.g., data, 

feedback from individuals outside of the population’s 

community, feedback from individuals within the 

population’s community, service providers, staff 

observation)?

__________________________________________________________________________

__________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

___________________________________________________________________________

S T E P 2 : I D E N T I F Y I N G 

R E S O U R C E S A B O U T T H E 

C O M M U N I T Y

Knowing where to find accurate information about a 

service community is invaluable when planning service 

delivery. The questions in Step 2 assist your agency 

with identifying resources (such as data, research, 

and studies) that help it understand the characteristics 

of the service population (such as family structure, 

community resources, and health disparities). 

Understanding the characteristics of a service 

population prepares your agency for Step 3, 

Designing Services.

Which resources does your agency’s staff use to obtain 

current information and training on providing services 

to this population? 

__________________________________________________________________________

__________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Has your agency offered staff opportunities to learn 

about this particular population? Yes No

If yes, please describe how these learning opportunities 

can help your agency provide better services to this 

population.

__________________________________________________________________________

__________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Can staff identify additional training or technical 

assistance that would be helpful in serving this 

population?

__________________________________________________________________________

__________________________________________________________________________

___________________________________________________________________________
4 6 U . S . A D M I N I S T R A T I O N O N A G I N G 

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

Which organizations, including current partners, 

can assist your agency and staff with learning how 

best to serve this population? (As you think about 

these organizations, consider whether or not they are 

organizations that are visible, respected, and trusted by 

the community your agency serves.)

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

____________________________________________________________________________

What do national, state, and local data reveal about 

the needs of this community (e.g., education, income, 

living arrangements)? 

U.S. Census Bureau: www.census.gov 

AoA Aging Statistics: www.aoa.gov/AoARoot/Aging_

Statistics/index.aspx

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

____________________________________________________________________________

What do disease and illness (morbidity) data reveal 

about the needs of this population? 

AoA statistics: www.aoa.gov/AoARoot/Aging_

Statistics/index.aspx

AHRQ National Healthcare Quality & Disparities 

Reports: www.ahrq.gov/qual/qrdr08.htm 

CDC National Health Statistics home page:

www.cdc.gov/nchs

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Based on state and community level data and 

community partners, how would your agency 

characterize the following? These answers might 

change as your agency gets more information 

from partners and verifies this information with the 

community.

a. Community-based supports

(e.g., family, church, grassroots organizations)

 Good Fair Poor

 

b. Social service resources 

 Good Fair Poor

c. Environmental conditions

(e.g., pollution/air quality)

 Good Fair Poor
 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

d. Public transportation

 Good Fair Poor

e. Economic stability 

 Good Fair Poor

f. Opportunities for community involvement

(e.g., socialization, volunteerism, clubs) 

 Good Fair Poor

 

How does this information (a – f) influence the types 

of services your agency provides for this population?

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

____________________________________________________________________________

Community’s most common family structure:

Nuclear Extended Other:

____________________________________________________

What are this community’s religious/spiritual beliefs 

and practices?

_______________________________________________________________________________

______________________________________________________________________________

_______________________________________________________________________________

______________________________________________________________________________

How will these religious/spiritual beliefs and practices 

influence the services your agency provides?

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

____________________________________________________________________________

These answers might change as your agency gets more 

information from partners and verifies this information 

with the service population.

Check all that apply:

______ Decisions are made by the client.

______ Decisions are made by the client and family 

member(s) (adult children/spouse/partner).

______ Decisions are made by the group consensus 

of various loved ones.

______ Decisions are made by another (in the case 

of homelessness, mental health issues, 

guardianship).

______ Females are the primary caretakers in this 

community.

______ Males are the primary caretakers in this 

community. 

______ Adult children are the primary caretakers in 

this community.
4 8 U . S . A D M I N I S T R A T I O N O N A G I N G 

______ Spouses/partners are the primary caretakers 

in this community.

______ Caretakers could be any loved one and/or 

individual in the community.

______ Another provides primary care (in the case 

of homelessness, mental health issues, 

guardianship).

What are the primary languages (including sign 

language) of this community?

____________________________________________________________________________________________

____________________________________________________________________________________________

__________________________________________________________________________________________ 

____________________________________________________________________________________________

____________________________________________________________________________________________

__________________________________________________________________________________________

Is this population historically an immigrant 

community? Yes No

If yes, how will the issue of immigration influence 

the types of services your agency provides (e.g., legal 

services, housing, employment)?

____________________________________________________________________________________________

____________________________________________________________________________________________

__________________________________________________________________________________________ 

____________________________________________________________________________________________

____________________________________________________________________________________________

__________________________________________________________________________________________

What are your agency’s plans to ensure that client 

input is used in the planning of services and their 

delivery (e.g., focus groups, interviews, consumer 

advisory boards, surveys)?

______________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

______________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

S T E P 3 : D E S I G N I N G 

S E R V I C E S 

Designing services that are respectful, inclusive, 

and sensitive is the hallmark of quality service delivery. 

The questions below assist your agency with defining 

what quality service means to a particular community 

based on its characteristics, which were explored 

in Step 2.

Based on the data your agency has collected about 

this service population, its community, and trusted 

organizations (e.g., churches, social clubs, grassroots 

nonprofit social services):

How should outreach and marketing materials 

be improved or implemented to 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 4 9

________________________________________________

________________________________________________

________________________________________________

________________________________________________

Do marketing/outreach materials show pictures of 

individuals from the community ? Yes No

Are marketing/outreach materials languageappropriate/bilingual? Yes No

Other marketing/outreach strategies:

________________________________________________

________________________________________________

________________________________________________

________________________________________________

________________________________________________

________________________________________________

Do marketing/outreach materials discuss public 

accessibility of services (e.g., building accessibility 

and which bus line, subway stop, senior transportation 

companies provide access to the service area)?

Yes No

If no, what steps does your agency plan to 

take to inform the service population of service 

accessibility?

________________________________________________

________________________________________________

________________________________________________

________________________________________________

________________________________________________

________________________________________________

How will marketing/outreach materials be pilot 

tested/reviewed, and by whom in the community 

(e.g., focus groups, interviews, surveys, consumer 

advisory board)?

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

____________________________________________________________________________

Do marketing/outreach materials indicate the 

availability of bilingual staff, including sign language 

interpreter(s)? Yes No

Which group in this population’s community would 

benefit most from your agency’s services (e.g., clients, 

caregivers, community organizations)?

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

____________________________________________________________________________
5 0 U . S . A D M I N I S T R A T I O N O N A G I N G 

Which services does your agency provide that would 

be 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 the 

community, in the home)?

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

____________________________________________________________________________

Which legal requirements (e.g., anti-discrimination 

laws, population targeting requirements, translation 

requirements) regarding service accessibility apply to 

services you provide to this population?

_______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

_______________________________________________________________________

______________________________________________________________________

Which steps does your agency plan to take to ensure 

that its policies, procedures, and services are aligned 

with legal requirements regarding service accessibility 

for this group (e.g., anti-discrimination laws, service 

population targeting requirements)?

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

____________________________________________________________________________

What are the structural barriers* that limit services 

for this group (e.g., transportation, childcare for 

grandchildren, health literacy/education, income)?

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

Which steps does your agency plan to take to reduce 

or eliminate structural barriers for this population?

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

____________________________________________________________________________

* Defined in Appendix B: Definitions
 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 1

What are the cultural barriers* that limit services to this 

group (e.g., stigma of accepting help, values concerning 

gender/family roles, religious/spiritual beliefs)?

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

____________________________________________________________________________

Which steps does your agency plan to take to reduce 

or eliminate cultural barriers* for this population? 

__________________________________________________________________________

__________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

____________________________________________________________________________

S T E P 4 : P R O G R A M 

E V A L U A T I O N

Program evaluation helps your agency make the case 

that it is being true to its commitment and mission to 

provide quality service to all older adults. The questions 

to follow allow your agency to consider how program 

evaluation can help it improve its services. 

Is a program evaluation approach established for the 

services this community needs and values the most? 

Yes No

If yes, which resources has your agency identified that 

can help with evaluating services for this community?

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

If no, how does your agency plan to evaluate those 

services?

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

Which partners or potential partners can help your 

agency evaluate services for this community?

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

* Defined in Appendix B: Definitions
5 2 U . S . A D M I N I S T R A T I O N O N A G I N G 

What is your agency’s plan for verifying evaluation 

results with partner, client, and community 

perceptions of your agency’s services (e.g., focus 

groups, interviews, surveys, questionnaires)?

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

Does your agency know the data collection barriers 

for this community (e.g., trust, confidentiality, previous 

negative experiences with research)?

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

What type of data collection methods align with 

the communication traditions of this community 

(oral tradition, written tradition, or both)? Should 

there be any special considerations made based on 

communication 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 is 

best for this community?

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

Does your agency plan to use both output (counting 

the number of times or occurrences of an activity), as 

well as outcome (results) measures? Yes No

If no, how does your agency plan to measure data? 

Which data measurement methods will it include?

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________
 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

How does your agency plan to use the data to improve 

services for this community? What is the data’s value 

to your agency, its partners, and the community?

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

How does your agency plan to share or disseminate its 

evaluation data and lessons learned to empower the 

community to engage in better self-advocacy?

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

Additional Notes:

______________________________________________________________________________________________________________________________________________________

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________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
5 4 U . S . A D M I N I S T R A T I O N O N A G I N G 

D E F I N I T I O N S A p e d i

The list of definitions presented in this appendix is intended as a starting point for users of this Toolkit. Agency staff 

and partners are encouraged to add to this list as needed. 

Acculturation 

The degree to which an individual adjusts, fits into, or 

adopts another culture as his/her own.

Assimilation

Adopting another cultural group’s values, beliefs, 

behaviors, and attitudes.

Cross-Cultural Communication 

Interaction between diverse individuals or groups.

Culture 

A group with shared values, religion, language, and/or 

heritage. (Culture refers to more than just race and 

ethnicity; it also applies to groups, their members, and 

affiliations.)

Cultural Awareness 

Being mindful, attentive, and conscious of

similarities and differences between cultural groups.*

Cultural Barrier 

A difference in cultural values and perceptions about 

treatment, care, and services that limit a person’s 

ability to access services.

Cultural Brokering

Bridging, linking, or mediating between groups or 

persons from different cultures to reduce conflict and/

or produce change.*

Cultural Competency

The capacity to function effectively as an individual 

or organization within the context of the cultural 

beliefs, behaviors, and needs of consumers and their 

communities.**

Cultural Misalignment of Services

When services do not fit or are not valued in a 

community.

* Goode, Tawara, Suganya Sockalingam, Lisa L. Snyder, Claire Dunne, and Isabella Lorenzo Hubert. 2004. The Essential Role 

of Cultural Broker Programs. Washington DC: Georgetown University, National Center for Cultural Competence.
 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

Cultural Proficiency 

Policies and practices of an organization, or values 

and behaviors of an individual, that enable the agency 

or person to interact effectively in a culturally diverse 

environment. Cultural proficiency is reflected in the 

way an organization treats its employees, clients, and 

community.***

Cultural Sensitivity 

Understanding the needs and emotions of one’s own 

culture and the culture of others, and understanding 

how the two may differ.*

Diversity 

Ethnic, socioeconomic, religious, and gender variety in 

a group, society, or institution.

Ethnic Group 

Individuals who share values, traditions, and social 

norms. 

Intercultural Differences 

Differences within cultures; for example, differences 

between Vietnamese, Chinese, Korean, Japanese, 

Filipino populations within the Asian culture.

Linguistic Competency

The ability of an organization to communicate 

effectively and convey information in a manner 

that is easily understood by diverse audiences.*

Operational Knowledge of Serving Diverse 

Populations 

A demonstration of how to serve diverse populations.

Race 

A division of humankind possessing traits that are 

transmissible by descent and sufficient to characterize 

it as a distinctive human type.

Structural Barrier

Technical or logistical factors that limit a person’s 

ability to access services.

Technical Knowledge of Serving Diverse Populations

Knowledge of how to serve diverse populations.

Worldview

The sum of a person’s or group’s perspectives 

including opinions, judgments, and beliefs based on 

culture, 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 for School Leaders. 

Thousand Oaks, CA: Corwin.
5 6 U . S . A D M I N I S T R A T I O N O N A G I N G 

D I V E R S I T Y C O N C E P T S A p e d i 

The list of concepts presented in this appendix is intended as a starting point for users of this Toolkit. Agency staff 

and partners are encouraged to add to these concepts. 

A D D R E S S I N G 

G E N E R A L I Z A T I O N S

When your agency begins to learn about serving 

diverse populations, it will quickly realize that there 

is a fine line between describing similar group 

behaviors and attitudes and generalizing about group 

behaviors and attitudes. So how can your agency truly 

understand diverse communities without generalizing? 

Professionals who work with aging populations can 

authentically understand differences without falling 

into the trap of generalizing by evaluating how diverse 

communities respond to your agency’s services.* Your 

agency can also understand differences by validating 

performance results with consumer advisory boards, 

focus groups, interviews, and survey data from clients 

and their communities.

Your agency will be serving diverse communities 

successfully when it offers services that are respectful, 

inclusive, and sensitive to the population it serves. 

Then your agency can grasp the difference between 

authentic understanding and generalizing.

C O L O R B L I N D T O R A C E

Some aging agencies believe it is simply better to be 

“colorblind to race.” The underlying assumption in 

this statement is that a person cannot possibly be 

prejudiced because he/she does not see race and, 

therefore, treats everyone the same. This position, 

although seemingly ideal, may not account for 

differences that may be at the core of defining what 

is respectful, inclusive, and sensitive service delivery 

for a particular community. While some people may 

not acknowledge racial differences, recognizing and 

addressing these differences may play a key role in 

understanding how to modify services to meet the 

needs of diverse communities successfully.

* To learn more about program evaluating, see Part I, Step 4: Program Evaluation, and Appendix 

G: List of Online Resources for Step 4.
 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

M E L T I N G P O T V S . 

S A L A D B O W L

The terms “melting pot” and “salad bowl” refer to 

different points of view of how people think about 

diversity in the United States. 

The melting pot viewpoint asserts that diverse groups 

will “melt” into the majority culture, or assimilate into 

the mainstream community or group, by adopting the 

values, beliefs, behaviors, and attitudes of the majority 

culture. 

The salad bowl viewpoint asserts that diverse groups 

never “melt” or disappear into the majority culture. 

Among salad bowl proponents, differences are both 

unique and valued, like each ingredient in a salad. 

Diverse groups experience degrees of assimilation, but 

cultural differences (including group affiliations, such 

as veterans) remain significant.
5 8 U . S . A D M I N I S T R A T I O N O N A G I N G 

D I S C U S S I O N S C E N A R I O S A p e d i 

The scenarios presented in this appendix are starting points for users of this Toolkit. Agency staff and partners are 

encouraged 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 G 

F O R A M E R I C A N I N D I A N 

C L I E N T S

Acculturation 

The degree to which an individual adjusts, fits into, 

or adopts another culture as his/her own.

Ethnic Group 

A group of individuals who share values, traditions, 

and social norms.

Cultural Brokering 

Bridging, linking, or mediating between groups or 

persons from different cultures to reduce conflict and/

or produce change.

Cultural Sensitivity 

Understanding the needs and emotions of one’s own 

culture and the culture of others.

An American Indian elder and his daughter come to 

the Area Agency on Aging (AAA) for assistance. When 

approached by a social worker and asked if they need 

help, the adult daughter states politely, “We are looking 

for Cynthia Ray.” Cynthia Ray is the only American Indian 

social worker at the AAA. The social worker replies, 

“Cynthia is not here today, but I can help you.” The elder 

states politely, “No thank you.” Then he and his daughter 

leave the AAA. The next week, the same client and his 

daughter return to the AAA for services. Another social 

worker approaches the client and his daughter and asks 

them if they need assistance. The client states politely, 

“No thank you.” After Cynthia Ray finishes with another 

client, the American Indian elder and his daughter 

approach Cynthia Ray for assistance. Social work staff see 

this occurrence and begin to notice that American Indian 

clients want to be served only by Cynthia Ray. While a few 

staff do not perceive this preference as a problem, most 

do and begin to call this preference “discrimination.” At 

the next staff meeting, the AAA director knows she must 

address this issue to ensure that respectful, inclusive, and 
 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

sensitive services are provided by her staff for American 

Indian elders and their families.

1. Does the staff’s reaction to the preferences 

of American Indian elders and their families 

demonstrate cultural sensitivity? Why or 

why not?

2. How do acculturation and ethnicity influence 

American Indian client preferences?

3. How can the AAA director use Cynthia Ray’s 

knowledge and gained trust to support the AAA’s 

services for American Indian elders and their 

families? (Think about roles for cultural brokering 

and staff education.)

4. Consider and discuss issues of trust regarding 

American Indian history and culture. Could 

a lack of trust be mistakenly interpreted as 

discrimination? Why or why not?

Supplemental Materials

To further explore the issue of acculturation, see:

Appendix E: Companion Presentations - John W. 

Berry’s Model of Acculturation Presentation 

A C C U L T U R A T I O N : A N 

A S I A N F A M I L Y A N D 

H O M E H E A L T H A I D

Intercultural Differences 

Differences within cultures; for example, differences 

between Vietnamese, Chinese, Korean, Japanese, and 

Filipino populations within the Asian culture.

Acculturation

The degree to which an individual adjusts, fits into, or 

adopts another culture as his/her own.

D E G R E E S O F 

A C C U L T U R A T I O N *

Assimilation 

While the client welcomes and fully socializes with 

individuals outside of his/her cultural group, to a lesser 

degree, the client stops embracing or valuing his/her 

own culture and begins to embrace another culture.

Integration 

The client welcomes and fully socializes with people 

both inside and outside of his/her cultural group. 

*Berry, J.W. 1997. Immigration, acculturation and adaptation. Applied Psychology: An International Review. 46:5-34.
6 0 U . S . A D M I N I S T R A T I O N O N A G I N G 

Separation

The client’s primary focus is maintaining values within 

his/her own culture rather than building relationships 

with people outside of his/her culture.

Marginalization 

The client does not socialize with people outside of 

his/her cultural group; nor does he/she focus on 

maintaining relationships within his/her cultural group.

An Asian-American family calls the Area Agency 

on Aging (AAA) to complain about a “rude” home 

health care provider. The family describes the 

African-American home health aide as “loud” and 

“confrontational.” The staff of the home health agency 

and AAA debate whether or not it is a cultural issue 

because the family also made the same complaint 

about a Caucasian aide. In an attempt to resolve the 

issue, the AAA works with the home health agency 

staff to determine what they believe to be a culturally 

appropriate match for the client. They send a 25-yearold Asian-American aide to the client. The complaints 

continue.

1. Could acculturation be an issue? If so, how?

2. How would you define the client and her family’s 

level of acculturation?

3. Could the African-American and Caucasian 

home health aides share the same level of 

acculturation?

4. Regarding the 25-year-old Asian-American health 

home aide, could acculturation and intercultural 

differences be an issue as well?

Supplemental Materials

To further explore the issue of acculturation, see:

Appendix E: Companion Presentations - John W. 

Berry’s Model of Acculturation Presentation 

T H E H E A R I N G I M P A I R E D 

O L D E R A D U L T : A N 

E X P E C T A T I O N O F 

S E R V I C E D E L I V E R Y

Cultural Awareness 

Being mindful, attentive, and conscious of similarities 

and differences between cultural groups.

Cultural Barrier 

A difference in cultural values and perceptions about 

treatment, care, and services that limit a person’s 

ability to access services.

Cultural Misalignment of Services

When services do not fit or are not valued in a 

community.

Structural Barrier

Technical or logistical factors that limit a person’s 

ability to access services.

Worldview

The sum of a person’s perspectives, including opinions, 

judgments, and beliefs based on culture, values, and 

life experiences.
 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

An older adult who has been deaf all of his life, is fluent 

in sign language, and reads lips, seeks services at the 

local Area Agency on Aging (AAA). While completing 

the client’s assessment, the service provider learns 

the client has been a long-time consumer of services 

for individuals with disabilities at the Center for 

Independent Living. After the assessment is completed, 

the service provider states loudly and slowly: “You 

should consider getting a hearing aid. I think I can 

identify some resources to cover that cost.” The client 

shakes his head, indicating “no,” while frowning at 

the aging professional. Using sign language he states, 

“Maybe I don’t need a hearing aid. Maybe you need to 

learn sign language.”

 

1. Do you think there is a cultural misalignment of 

services? Why or why not?

2. How do the worldview of the client and the 

worldview of the professional vary? 

3. Are there any structural and/or cultural barriers 

to providing services for this client?

4. How does cultural awareness play into this 

situation?

Supplemental Materials

To further explore the topics of barriers to service and 

worldview, see:

Appendix E: Companion Presentations - Barriers 

to Serving Diverse Communities, Worldview 

Presentation

H 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 S

Cultural Barrier 

A difference in cultural values and perceptions about 

treatment, care, and services that limit a person’s 

ability to access services.

Cultural Sensitivity 

Understanding the needs and emotions of one’s own 

culture and the culture of others.

Structural Barriers 

Technical or logistical factors that limit a person’s ability 

to access services.

In the last few years, Area Agency on Aging (AAA) staff 

in two regions of the state have noticed an increase in 

homeless older adults in their service areas. To address 

the needs of this population, a group of AAA staff writes 

a proposal with components for transitional housing, 

housing placement and assistance, job counseling, 

training and placement, energy assistance, and 

meals. The aging services professionals present the 

proposal to a community partner that serves homeless 

individuals. The partnering agency tells the aging 

services professionals they are missing very basic and 

critical components in the proposal. One problem is 

that the proposal starts with service provision at the 

AAAs, but the partner believes homeless older adults 

need a series of other services before they even walk 

into an AAA and ask for assistance.
6 2 U . S . A D M I N I S T R A T I O N O N A G I N G 

1. What could those “basic” and “critical” 

services be?

2. Could there be cultural barriers, structural 

barriers, or both regarding those services?

3. How can the partnering agency help the 

AAAs serve this community better?

Supplemental Materials 

To further explore this issue, see:

Appendix E: Companion Presentations - Barriers to 

Serving Diverse Communities Presentation

Appendix F: Companion Exercises - Structural or 

Cultural Barrier

P R E V I O U S L Y 

I N C A R C E R A T E D O L D E R 

A D U L T S : B A R R I E R S T O 

S E R V I C E

Cultural Barrier

A difference in cultural values and perceptions about 

treatment, care, and services that limit a person’s 

ability to access services.

Structural Barrier

Technical or logistical factors that limit a person’s 

ability to access services.

Worldview 

The sum of a person’s or group’s perspectives, 

including opinions, judgments, and beliefs based on 

culture, values, and life experiences.
 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

Two Area Agency on Aging (AAA) directors have 

a routine phone conversation about a regional 

conference. At the end of the conversation, each 

mentions an increase in previously incarcerated older 

adult men seeking services at their AAAs. Both agree 

that “something” needs to be done to address this 

population because trends in data indicate increases 

in longer sentencing. Longer sentences lead to the 

release of older adults into the community who may 

need home- and community-based services in addition 

to transitional services tailored to meet their specific 

circumstances. Both directors feel a sense of urgency 

as they discuss how their staff shared resources with 

these clients, but knew that the AAA “fell short” of 

meeting these clients’ needs.

1. What could be some of the cultural barriers to 

providing services for this population?

2. What could be some of the structural barriers to 

providing services for this population?

3. With regard to opinions, judgments, and beliefs 

(worldviews) about serving this population, what 

could be some of the barriers these directors 

could encounter with AAA staff? 

T H E O L D E R A D U L T 

L 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 S 

Cultural Awareness 

Being mindful, attentive, and conscious of similarities

and differences between cultural groups.

Cultural Barrier 

A difference in cultural values and perceptions about 

treatment, care, and services that limit a person’s 

ability to access services.

Cultural Sensitivity 

Understanding the needs and emotions of one’s own 

culture and the culture of others.

Operational Knowledge of Serving Diverse Populations

A demonstration of how to serve diverse populations.

Technical Knowledge of Serving Diverse Populations

Knowledge of how to serve diverse populations.

An aging services professional enters a female client’s 

demographic information into a database to receive 

hospice care for cancer. The client tells the professional 

that her doctors have diagnosed her with terminal 

cancer. The professional asks the client, “Who would 

you like us to contact in case of an emergency?” The 

client responds while placing her hand over the hand of 

the woman beside her, “My partner Lynn is the person 

I trust. We’ve been together for 12 years now. She’s 

the person I want you to consult. We make decisions 

together.” Lynn then provides the professional with her 

full name. When the professional asks the client about 

Lynn’s relationship to her, the client states, “I just told 

you. She’s my partner. We live together.” The aging 

services professional says to the client, “I need the 

name of a family member.” The client states, “Lynn is 

my spouse.”
6 4 U . S . A D M I N I S T R A T I O N O N A G I N G 

Did the aging services professional’s cultural awareness 

meet the expectations of the client? Why or why not?

1. Based on the professional’s response, could a 

cultural barrier to service occur?

2. Did the professional demonstrate technical 

knowledge or operational knowledge? Why or 

why not?

3. How can partnering with a trusted LGBT 

community organization assist this Area Agency 

on Aging?

Supplemental Materials

To further explore the issue of worldview and barriers to 

services, see:

Appendix E: Companion Presentations - Worldview 

Presentation 

D I F F E R E N T W O R L D V I E W S 

O F L E A D E R S H I P

Cross-Cultural Communication 

Interaction between diverse individuals or groups.

Culture

A group with shared values, religion, language, and/

or heritage. (Culture refers to more than just race and 

ethnicity; it also applies to groups, their members, 

and affiliations.)

Cultural Awareness 

Being mindful, attentive, and conscious of similarities 

and differences between cultural groups.

Cultural Brokering 

Bridging, linking, or mediating between groups or 

persons from different cultures to reduce conflict and/

or produce change.

Cultural Sensitivity 

Understanding the needs and emotions of one’s own 

culture and the culture of others.

Worldview 

The sum of a person’s or group’s perspectives, 

including opinions, judgments, and beliefs based on 

values and life experiences.

A group of professionals from the Aging Network attend 

a meeting with HIV/AIDS advocates to begin planning 

an older adult HIV/AIDS advocacy organization. Each 

group recognizes an increase in the rate of HIV/AIDS 

infection among community residents aged 55 and 

older. In anticipation of the need for social service 

resources and advocacy for older adults living with 

HIV/AIDS, each group recognizes the significance of 

creating such an organization. During the meeting, 

each group discovers the other has a different vision of 

leadership.

Both groups want an older adult to lead the advocacy 

organization. However, the HIV/AIDS advocates want an 

older adult who is living with HIV/AIDS to take a very 

visible and active leadership role in the organization. 
 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

They argue that this individual will bring a unique 

perspective to understanding what it means to live with 

HIV/AIDS. They state in the meeting: “Aging Network 

staff just don’t have that kind of knowledge.” The Aging 

Network staff respond, “An individual doesn’t have to 

have HIV/AIDS to represent those who are infected by 

the virus.” The aging services providers add that people 

with HIV/AIDS can be represented on the consumer 

advocacy board. “That’s what those boards are for,” 

they state. The HIV/AIDS advocates respond, “That 

simply isn’t good enough.” Both groups leave the 

meeting frustrated.

1. What may be some of the opinions, judgments, 

beliefs, and/or values each group has about 

leadership (worldview) that are stated or implied?

2. Which worldview of consumer advocacy is 

respected and by whom?

3. Is each group demonstrating cultural awareness? 

Why or why not?

4. Is each group demonstrating skills in crosscultural communication? Why or why not?

5. Is each group demonstrating skills in cultural 

sensitivity? Why or why not?

6. How could a cultural broker assist these groups?

7. Could this example be applied to the Aging 

Network establishing relationships with the 

Disability Network? If so, what could be some 

of the worldview implications of starting a 

partnership with groups representing these older 

adult populations?

Supplemental Materials

To further explore the issue of worldview, see:

Appendix E: Companion Presentations -

Worldview Presentation
6 6 U . S . A D M I N I S T R A T I O N O N A G I N G 

A p e d ix E C O M P A N I 

P R E S E N T A T I O N S
 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

The presentations presented in this appendix represent a starting point for users of this Toolkit. Agency staff and 

partners are encouraged to create and share their own presentations. 
6 8 U . 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 6 9
7 0 U . 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 7 1
7 2 U . 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 7 3
7 4 U . 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 7 5
7 6 U . 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 7 7
7 8 U . 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 7 9
8 0 U . 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 8 1
8 2 U . 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 8 3
8 4 U . 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 8 5
8 6 U . 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 8 7
8 8 U . 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 8 9
9 0 U . 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 9 1
9 2 U . 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 9 3
9 4 U . 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 9 5
9 6 U . 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 9 7
9 8 U . 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 9 9
1 0 0 U . 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 101
1 0 2 U . 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 103
1 0 4 U . S . A D M I N I S T R A T I O N O N A G I N G 

C O M P A N I O N E X E R C I S E S A p e d i

The exercises presented in this appendix represent a starting point for users of this Toolkit. Agency staff and 

partners 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 G

Answers to definitions are provided in Appendix B.

Race A group with shared values, religion, language, and/or heritage.

The capacity to function effectively as an individual or 

Ethnic Group organization within the context of the cultural beliefs, 

behaviors, and needs of consumers and their communities.

Policies and practices of an organization, or values and 

Culture behaviors of an individual, that enable the agency or person 

to interact effectively in a culturally diverse environment.

Diversity Ethnic, socioeconomic, religious, and gender variety in a 

group, society, or institution.

Cultural Competency Individuals who share values, traditions, and social norms.

A division of humankind possessing traits that are 

Cultural Proficiency transmissible by descent and sufficient to characterize it as a 

distinctive human type.
 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

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 R 

 S T R U C T U R A L B A R R I E R

C U L T U R A L B A R R I E R

A difference in cultural values and perceptions 

about treatment, care, and services that limit a 

person’s ability to access services. 

S T R U C T U R A L B A R R I E R 

Technical or logistical factors that limit a 

person’s ability to access services.

Which of the issues below are examples of structural 

or cultural barriers? Why or why not?

Is it possible the issues could result in both structural 

and cultural barriers? 

Regarding each of the situations, how do an agency’s 

cultural (institutional) values influence barriers?

1. An agency that lacks wheelchair accessibility.

Cultural or Structural

Influence: 

_____________________________________________________

____________________________________________________

____________________________________________________

2. A client delaying a decision to sign up for needed 

services because his/her partner is not available 

to participate in the decisionmaking process.

Cultural or Structural

Influence: 

_____________________________________________________

____________________________________________________

____________________________________________________
1 0 6 U . S . A D M I N I S T R A T I O N O N A G I N G 

3. A client living by a bus route that suspends

services during non-rush hours.

Cultural or Structural

Influence: 

_____________________________________________________

____________________________________________________

____________________________________________________

4. A client requesting a sign-language interpreter.

Cultural or Structural

Influence: 

_____________________________________________________

____________________________________________________

____________________________________________________

5. An agency distributing the same outreach 

brochures to different diverse communities.

Cultural or Structural

Influence: 

_____________________________________________________

____________________________________________________

____________________________________________________

6. An agency unaware of community-based partners 

providing services to the same diverse community 

group for which it is also providing services.

Cultural or Structural

Influence: 

_____________________________________________________

____________________________________________________

____________________________________________________

7. An agency serving communities that have no 

advisory or consumer board representation.

Cultural or Structural

Influence: 

_____________________________________________________

____________________________________________________

____________________________________________________

8. An agency making the decision to collect only 

quantitative (statistical/numeric) client data. 

Cultural or Structural

Influence: 

_____________________________________________________

____________________________________________________

____________________________________________________

9. An agency creating a policy option for board 

members to complete self-assessments.

Cultural or Structural

Influence: 

_____________________________________________________

____________________________________________________

____________________________________________________
 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

E X E R C I S E 3 : T E C H N I C A L 

O R O P E R A T I O N A L 

K N O W L E D G E ? 

While the goal of this exercise is to identify each statement as 

an example of technical knowledge, operational knowledge, 

or both, the purpose of this exercise is to stimulate discussion 

among agency staff and partners about the differences between technical and operational knowledge. Therefore, no prescriptive answer is provided. Learning is encouraged through 

discussion based on knowledge, background, and experiences.

Technical knowledge is understanding how to serve 

diverse populations: “I can tell you.”

Operational knowledge is demonstrating how to serve 

diverse populations: “I can show you.”

Technical

Operational

1. Staff acquire first-level training 

in cultural competency.

Technical

Operational

2. Staff utilize a nutritional 

assessment that asks elderly 

Jewish clients if their non-Jewish 

caretakers need experience 

with cooking Kosher foods and 

maintaining a Kosher kitchen.

Technical

Operational

3. An agency completes an 

organizational cultural 

competency assessment.

Technical

Operational

4. An agency completes an organizational cultural competency 

assessment and uses the results 

to implement and enhance 

policies.

Technical

Operational

5. A program manager changes the 

vision statement of a program 

targeted to an American Indian 

caregiving service to reflect the 

cultural values of that community.

Technical

Operational

6. An agency invites American Indian 

elders and their families to assist 

with creating the vision statement 

and its family caregiving service to 

reflect the cultural values of that 

community.

Technical

Operational

7. An agency provides staff with 

guidance for supporting immigrant 

families caring for family members 

with Alzheimer’s disease.

Technical

Operational

8. An agency creates an intergenerational veteran support program 

that includes older adult veterans 

that mentor younger, recently 

discharged veterans.

Technical

Operational

9. Staff pass out health care brochures from a partnering clinic 

advertising free health care 

services for migrant worker 

families.

Technical

Operational

10. A state’s Aging Network partners 

with local non-denominational 

religious organizations to address 

increasing numbers of older adults 

with HIV/AIDS.
1 0 8 U . S . A D M I N I S T R A T I O N O N A G I N G 

L I S T O F O N L I N E R E S O U R C E S A p e d i

The list of resources presented in this appendix represents a starting point for users of this Toolkit. Agency staff 

and 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 S

Organizational and staff assessments

A Guide to Planning and Implementing Cultural Competence Organizational Self-Assessment

National Center for Cultural Competence, Georgetown University 

http://www11.georgetown.edu/research/gucchd/nccc/documents/ncccorgselfassess.pdf

A Guide for Using the Cultural and Linguistic Competence Policy Assessment Instrument

National Center for Cultural Competence, Georgetown University

http://www.clcpa.info/documents/CLCPA_guide.pdf

Checklist to Facilitate the Development of Culturally and Linguistically Competent Primary Health 

Care Policies and Structures: Rationale for Cultural Competence in Primary Health Care

National Center for Cultural Competence, Georgetown University

http://www11.georgetown.edu/research/gucchd/nccc/documents/Policy%20Brief%201%20Checklist.pdf

Checklist to Facilitate the Development of Linguistic Competence within Primary Health Care Organizations: 

Linguistic Competence in Primary Health Care Delivery Systems Implications for Policy Makers 

National Center for Cultural Competence, Georgetown University

http://www11.georgetown.edu/research/gucchd/nccc/documents/Policy%20Brief%202%20Checklist.pdf

Cultural and Linguistic Competence Policy Assessment 

National Center for Cultural Competence, Georgetown University 

http://www.clcpa.info/documents/CLCPA.pdf

Cultural Competency Organizational Self-Assessment

AIDS Education Training Centers, National Resource Centers 

http://www.aidsetc.org/doc/workgroups/cc-question-bank.doc

Diversity and The Aging Network: An Assessment Handbook

National Aging Resource Center: Long-Term Care, Brandeis University

http://www.alz.org/national/documents/GEN_ASSESS-LTCDiversityHandbook.pdf

Note: Disclaimer from the U.S. Administration on Aging (AoA) 

Information presented in this document does not constitute an endorsement or recommendation by the U.S. Administration on Aging or any of 

its employees. The AoA is not responsible for the contents of any referenced Web page(s) and does not endorse any specific product or service 

provided by public or private organizations. The user takes full responsibility for accessing any of the referenced links.
 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 109

Assessment of Organizational Cultural Competence 

Association of University Centers on Disabilities (AUCD) Multicultural Council

http://www.aucd.org/docs/councils/mcc/cultural_competency_assmt2004.pdf

Self-assessments

Self-Assessment of Cultural Competence

Association of University Centers on Disabilities (AUCD) Multicultural Council

http://www.acphd.org/AXBYCZ/Admin/Publications/ddc_self_assess_cultural_competence.doc

Cultural Competence Self-Assessment Questionnaire: A Manual for Users

Portland University

http://www.rtc.pdx.edu/PDF/pbCultCompSelfAssessQuest.pdf

Promoting Cultural and Linguistic Competency: Self-Assessment Checklist for Personnel 

Providing Primary Health Care Services

National Center for Cultural Competence, Georgetown University 

http://www11.georgetown.edu/research/gucchd/nccc/documents/Checklist%20PHC.pdf

Rationale for Self-Assessment Checklist

National Center for Cultural Competence, Georgetown University 

http://www11.georgetown.edu/research/gucchd/nccc/orgselfassess.html

Assessment tools 

The Cross Cultural Health Care Program 

http://www.xculture.org/assesstools.php

S T E P 2 : I D E N T I F Y I N G R E S O U R C E S 

A B O U T T H E C O M M U N I T Y

Agency knowledge of service community

Inclusiveness at Work: How to Build Inclusive Nonprofit Organizations

The Denver Foundation

Module 5: Information Gathering, Part 1: Available Facts
1 1 0 U . S . A D M I N I S T R A T I O N O N A G I N G 

http://www.nonprofitinclusiveness.org/files/Module%205.pdf

Module 7: Information Gathering, Part 3: Compiling Results

http://www.nonprofitinclusiveness.org/files/Module%207.pdf

Module 14: Programs and Constituents 

http://www.nonprofitinclusiveness.org/files/Module%2014.pdf

Stakeholder Management

Curtin University of Technology, School of Architecture Construction and Planning

http://www.e-campus21.com/courseware/notes/CourseMaterials/CME/PM442/PM442/topic8.pdf

Partnerships and coalition building

Bridging the Cultural Divide in Health Care Settings: The Essential Role of Cultural Broker Programs

The National Center for Cultural Competence at the Georgetown University 

http://www11.georgetown.edu/research/gucchd/nccc/resources/brokering.html

Developing Effective Coalitions: An Eight Step Guide

The Prevention Institute

http://www.preventioninstitute.org/pdf/eightstep.pdf

Improving Stakeholder Collaboration: A Special Report on Community-Based Health Efforts

Group Health Community Foundation 

http://www.cche.org/pubs/ghcf-publication-stakeholder-collaboration.pdf

Inclusiveness at Work: How to Build Inclusive Nonprofit Organizations

The Denver Foundation

http://www.nonprofitinclusiveness.org/inclusiveness-work-how-build-inclusive-nonprofit-organizations

Ten Myths that Prevent Collaboration Across Cultures

Awesome Library, Evaluation and Development Institute

http://www.awesomelibrary.org/multiculturaltoolkit-myths.html

Client and community data

Aging Statistics

U.S. Administration on Aging, U.S. Department of Health and Human Services

http://www.aoa.gov/AoARoot/Aging_Statistics/index.aspx

Bureau of Labor Statistics

U.S. Department of Labor

www.bls.gov

Federal Interagency Forum on Aging Related Statistics

www.AgingStats.gov

Inclusiveness at Work: How to Build Inclusive Nonprofit Organizations

The Denver Foundation (See Partnerships and Coalition Building)

http://www.denverfoundation.org/File Download.cfm?file=IAW_intro.pdf

Migration and Data Reports

U.S. Census Bureau

http://www.census.gov/population/www/cen2000/migration.html

Note: Disclaimer from the U.S. Administration on Aging (AoA) 

Information presented in this document does not constitute an endorsement or recommendation by the U.S. Administration on Aging or any of 

its employees. The AoA is not responsible for the contents of any referenced Web page(s) and does not endorse any specific product or service 

provided by public or private organizations. The user takes full responsibility for accessing any of the referenced links.
 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 111

Minority Health 

National Institutes of Health, U.S. Department of Health and Human Services

http://health.nih.gov/category/MinorityHealth

National Healthcare Disparities Report

Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services

http://www.ahrq.gov/qual/qrdr08.htm

Office of Minority Health, U.S. Department of Health and Human Services

http://www.omhrc.gov/

Office of Refugee Resettlement, Administration of Children and Families

U.S. Department of Health and Human Services

http://www.acf.hhs.gov/programs/orr/data/05arc10appendixC.htm

Racial and Ethnic Populations, Office of Minority Health and Health Disparities

Centers for Disease Control and Prevention, U.S. Department of Health and Human Services

http://www.cdc.gov/omhd/Populations/populations.htm

Rural and Diversity Briefing

Economic Research Service, U.S. Department of Agriculture

http://www.ers.usda.gov/Briefing/Population/Diversity.htm

Selected Long-Term Care Statistics

Family Caregiver Alliance 

http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=440

Selected Caregiver Statistics

Family Caregiver Alliance

http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=439

Trends in Vision and Hearing Among Older Americans

Centers for Disease Control and Prevention, U.S. Department of Health and Human Services

http://www.cdc.gov/nchs/data/ahcd/agingtrends/02vision.pdf

U.S. Census Bureau

http://www.census.gov/

Women and Caregiving: Facts and Figures

Family Caregiver Alliance 

http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=892

Client input

Basics of Conducting Focus Groups

Free Management Library

http://www.managementhelp.org/grp_skll/focusgrp/focusgrp.htm

Effective Questioning 

Free Management Library

http://www.managementhelp.org/commskls/qustning/old_qust.htm
1 1 2 U . S . A D M I N I S T R A T I O N O N A G I N G 

Inclusiveness at Work: How to Build Inclusive Non-Profit Organizations

The Denver Foundation

Module 6: Information Gathering, Part 2: Stakeholder Perspectives

http://www.nonprofitinclusiveness.org/files/Module%206.pdf

S T E P 3 : D E S I G N I N G S E R V I C E S

Outreach/Marketing

Getting the Word Out: Effective Health Outreach to Cultural Communities 

The Medtronic Foundation

http://www.medtronic.com/downloadablefiles/outreach_brochure.pdf

A Guide to Choosing and Adapting Culturally and Linguistically Competent Health Promotion Materials

National Center for Cultural Competence, Georgetown University

http://www11.georgetown.edu/research/gucchd/nccc/documents/Materials_Guide.pdf

Inclusiveness at Work: How to Build Inclusive Non-Profit Organizations

Module 15: Marketing and Community Relations

The Denver Foundation

http://www.nonprofitinclusiveness.org/files/Module%2015.pdf

Tried and True Methods for Reaching Under-Served Populations

National Long Term Care Ombudsman Resource Center

http://www.ltcombudsman.org/sites/default/files/norc/Tried-and-True-Methods.pdf

Service design and delivery

Developing Culturally-Competent Individual Service Plans for Wellness, Recovery and Resilience

Neal Adams, M.D., California Department of Mental Health

http://www.afteradoption.org/Wraparound/strengthbasedserviceplans.ppt#293

How Well Does Your Agency Provide Client-centered Services?

Center for Health Training

http://www.centerforhealthtraining.org/documents/agency_assess.pdf

Making CLAS Happen: Six Areas for Action

A Guide to Providing Culturally and Linguistically Appropriate Services (CLAS) in a Variety of Public Health Settings

Massachusetts Department of Public Health, Office of Health Equity 

http://www.mass.gov/Eeohhs2/docs/dph/health_equity/clas_intro.doc

Cultural Competency

Homestead Schools, Inc. – Social Work

Chapter 4 – Developing Cultural Competence

http://www.homesteadschools.com/LCSW/courses/CulturalCompetence/Chapter04.html

Chapter 8 – Achieving Cultural Competence: A Guidebook for Providers of Services to Older Americans and Their Families 

http://www.homesteadschools.com/LCSW/courses/CulturalCompetence/Chapter08.html

Note: Disclaimer from the U.S. Administration on Aging (AoA) 

Information presented in this document does not constitute an endorsement or recommendation by the U.S. Administration on Aging or any of 

its employees. The AoA is not responsible for the contents of any referenced Web page(s) and does not endorse any specific product or service 

provided by public or private organizations. The user takes full responsibility for accessing any of the referenced links.
 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 113

Serving diverse communities: challenges, barriers, and best practices 

Strategy Brief: Ombudsman Program Responses to Diversity

National Association of State Units on Aging

http://www.nasua.org/pdf/Diversity%20Dialogue.pdf

Chronic Disease and Pain Management – Part I PowerPoint Presentation

Hee Yun Yee, Ph.D., Assistant Professor, School of Social Work, University of Minnesota 

http://www.cehd.umn.edu/SSW/ContinuingEd/Documents/Module%206/Chronic%20Disease%20-%20Part%20I.pdf

Health Literacy and Cultural Competency

Chronic Disease and Pain Management Fact Sheet

School of Social Work, University of Minnesota

http://www.cehd.umn.edu/ssw/ContinuingEd/Documents/Module%206/Reading%20guide%20-%20Module%206.pdf

Promising Practices Issue Brief: Respecting Diversity

Reaching Out Through Local Elder Abuse Networks

National Center on Elder Abuse

http://www.ncea.aoa.gov/ncearoot/Main_Site/pdf/PromisingPracticesRespectingDiversity.pdf

Senior Nutrition Programs: Promising Practices for Diverse Populations

New Jersey Department of Health and Senior Services

http://www.state.nj.us/health/senior/nutrition/documents/nutrition.pdf

S T E P 4 : P R O G R A M E V A L U A T I O N

Organization and client evaluation of services

Basic Guide to Program Evaluation

Carter McNamara, M.B.A., Ph.D.

http://208.42.83.77/evaluatn/fnl_eval.htm

An Evaluation Framework for Community Health Programs

The Center for Advancement of Community Based Public Health

http://www.cdc.gov/eval/evalcbph.pdf

Everything You Wanted to Know About Logic Models but Were Afraid to Ask

Connie C. Schmitz and Beverly A. Parsons, InSites

http://www.insites.org/documents/logmod.htm

Engaging New Families in Evaluation

Federation of Families for Children’s Mental Health

http://ffcmh.org/wp-content/uploads/2009/pdffiles/Engaging%20New%20Families%20in%20Evaluation%20-%20Eng.pdf

Spanish version: http://ffcmh.org/wp-content/uploads/2009/pdffiles/Engaging%20New%20Families%20in%20Evaluation%20-%20Spa.pdf

A Framework for Program Evaluation: The Logic Model and Evaluation Framework

Center for Addiction and Mental Health, University of Toronto

http://www.problemgambling.ca/EN/ResourcesForProfessionals/Pages/AFrameworkforProgramEvaluation.aspx
1 1 4 U . S . A D M I N I S T R A T I O N O N A G I N G 

How Do Measures Measure Up? 

Evangeline Danesco, Ph.D.

The Provincial Center of Excellence for Child and Youth Mental Health

http://onthepoint.smartsimple.biz/files/237865/f93611/Measures_Webinar_Slides_EN.ppt

The Legality of Collecting and Disclosing Patient Race and Ethnicity Data

Robert Wood Johnson Foundation and The George Washington University Medical Center

http://www.rwjf.org/files/publications/other/RaceEthnicDisparitiesData06222006.pdf

Participatory Program Evaluation Manual: Involving Program Stakeholders in the Evaluation 

Process

Judi Aubel, Ph.D., M.P.H.,

Child Survival Technical Support Project and Catholic Relief Services

http://www.idrc.ca/uploads/user-S/10504133390Participatory_Program_Evaluation_Manual.pdf

Tools for Measuring Health Conditions

Resource Centers for Minority Aging Research, National Institute on Aging

National Institutes of Health, U.S. Department of Health and Human Services

http://www.musc.edu/dfm/RCMAR/RCMARTools.html

Toward Culturally Competent Evaluation in Health and Mental Health

The California Endowment

http://www.calendow.org/uploadedFiles/Publications/Evaluation/toward_culturally_competent_evaluation.pdf

Types of Program Evaluation

Center for Addiction and Mental Health, University of Toronto

http://www.problemgambling.ca/EN/ResourcesForProfessionals/Pages/TypesofProgramEvaluation.aspx

Lessons learned

Ensure Use of Evaluation Findings and Lessons Learned (tobacco cessation)

Centers for Disease Control and Prevention, U.S. Department of Health and Human Services

http://www.cdc.gov/tobacco/tobacco_control_programs/surveillance_evaluation/evaluation_manual/pdfs/chapter6.pdf

Family Engagement in Evaluation: Lessons Learned

Federation of Families for Children’s Mental Health

http://ffcmh.org/researchandpublications/FamilyEngagementinEvaluation.pdf

O 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 S

A _______________________________________________________________________________________________________________________________________________________________

African-American/Black 

Adaptation of an HIV Prevention Curriculum for Use With Older African American Women

Journal of the Association of Nurses in AIDS Care

http://www.oneloveca.org/_files/_files/5245_california-CorneliusOlderAAfemHIVp08.pdf

African Americans and Alzheimer’s Disease: The Silent Epidemic

Alzheimer’s Association

http://www.alz.org/Resources/Diversity/downloads/AA_EDU-SilentEpidemic.pdf

Note: Disclaimer from the U.S. Administration on Aging (AoA) 

Information presented in this document does not constitute an endorsement or recommendation by the U.S. Administration on Aging or any of 

its employees. The AoA is not responsible for the contents of any referenced Web page(s) and does not endorse any specific product or service 

provided by public or private organizations. The user takes full responsibility for accessing any of the referenced links.
 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 115

African American Health Coalition

http://www.aahc-portland.org/aboutUs.htm

Healthy Minds. Healthy Lives. 

African Americans

American Psychiatric Association

http://healthyminds.org/More-Info-For/African-Americans.aspx

Mental Health: A Report of the Surgeon General

Chapter 3: Mental Health Care for African-Americans

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services

http://mentalhealth.samhsa.gov/cre/ch3.asp

National Caucus and Center on Black Aged

http://www.ncba-aged.org/

African-American Programs

American Diabetes Association

http://www.diabetes.org/community-events/programs/african-american-programs/

Serving African American Families: Home and Community Based Services for People with Dementia and Their Caregivers

Alzheimer’s Association 

http://www.aoa.gov/AoARoot/AoA_Programs/HCLTC/Alz_Grants/docs/Toolkit_4_Serving_African_Americans.pdf

American Indian and Alaskan Native

Centers for American Indian and Alaska Native Health

University of Colorado – Denver

http://aianp.uchsc.edu/nerc/nerc_index.htm

Changing Direction: Strengthening the Shield of Knowledge

Building Understanding that Leads to Cross-Cultural Competence

AIDS Education and Training Centers, National Resource Center

http://www.aidsetc.org/aidsetc?page=et-04-01

Diabetes Program Affiliates

Association of American Indian Physicians

http://www.aaip.org/?page=DAFFILIATES

CultureCard: A Guide to Build Cultural Awareness, American Indian and Alaska Native

U.S. Department of Health and Human Services

http://download.ncadi.samhsa.gov/ken/pdf/SMA08-4354/CultureCard_AI-AN.pdf

Indian Health Service

U.S. Department of Health and Human Services

http://www.ihs.gov/

Indigenous People and the Social Work Profession: Defining Culturally Competent Services

Hillary N. Weaver, School of Social Work, State University of New York 

National Association of Social Workers

http://www.socialworkers.org/diversity/ethnic/weaver.pdf
1 1 6 U . S . A D M I N I S T R A T I O N O N A G I N G 

Mental Health: A Report of the Surgeon General

Chapter 4: Mental Health Care for American Indians and Alaska Natives

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services

http://mentalhealth.samhsa.gov/cre/ch4.asp

National Indian Council on Aging

http://www.nicoa.org/

National Indian Health Board

http://www.nihb.org/public_health/public_health.php

National Native American AIDS Prevention Center

http://www.nnaapc.org/

National Resource Center for American Indian, Alaska Native and Native Hawaiian Elders 

University of Alaska Anchorage

http://elders.uaa.alaska.edu/about.htm

National Resource Center on Native American Aging

Center for Rural Health, University of North Dakota

http://ruralhealth.und.edu/projects/nrcnaa/publications.php

Diabetes and Native Americans 

American Diabetes Association

http://www.diabetes.org/community-events/programs/native-american-programs/

Understanding Disabilities in American Indian and Alaska Native Communities: Toolkit Guide

National Council on Disability 

http://www.ncd.gov/newsroom/publications/2003/native_toolkit.htm

Asian American and Pacific Islander

Healthy Minds. Healthy Lives. 

Asian American/Pacific Islanders

American Psychiatric Association

http://healthyminds.org/More-Info-For/Asian-AmericanPacific-Islanders.aspx

Association of Asian Pacific Community Health Organizations

http://www.aapcho.org/site/aapcho/

Asian American Health

U.S. National Library of Medicine, National Institutes of Health 

http://asianamericanhealth.nlm.nih.gov/

Mental Health: A Report of the Surgeon General

Chapter 5: Mental Health Care for Asian Americans and Pacific Islanders

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services

http://mentalhealth.samhsa.gov/cre/ch5.asp

National Resource Center for Native Hawaiian Elders

Myron B. Thompson School of Social Work, University of Hawaii

http://manoa.hawaii.edu/hakupuna/publications.html

Note: Disclaimer from the U.S. Administration on Aging (AoA) 

Information presented in this document does not constitute an endorsement or recommendation by the U.S. Administration on Aging or any of 

its employees. The AoA is not responsible for the contents of any referenced Web page(s) and does not endorse any specific product or service 

provided by public or private organizations. The user takes full responsibility for accessing any of the referenced links.
 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 117

National Asian Pacific Center on Aging

http://www.napca.org/

National Resource Center for American Indian, Alaska Native and Native Hawaiian Elders:

University of Alaska Anchorage

http://elders.uaa.alaska.edu/about.htm

Reducing Health Disparities in Asian Pacific Islander Populations

The Providers Guide to Quality Care

http://erc.msh.org/aapi/index.html

Serving Asian and Pacific Islander Families: Home and Community-Based Services for People with Dementia and Their Caregivers 

Alzheimer’s Association

http://www.aoa.gov/AoARoot/AoA_Programs/HCLTC/Alz_Grants/docs/Toolkit_5_Serving_Asian_Pacific_Islanders.pdf

C _______________________________________________________________________________________________________________________________________________________________

Caregiving

Cultural Diversity and Caregiving

Family Caregiver Alliance, National Center on Caregiving

http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=1880 

Cultural Competence & Diversity Guidance, Resources, and Training Materials

Aging and Diversity: Module 2 – Diversity

AgeWorks

http://www.ageworks.com/course_demo/380/module2/module2.htm

America’s Diversity Guide

National Association of State Units on Aging

http://www.nasua.org/issues/tech_assist_resources/national_aging_ir_support_ctr/diversity_guide/index.html

The Cross Cultural Health Care Program

http://www.xculture.org/cultcompprograms.php

Culture Clues 

Patient and Family Education Services, University of Washington Medical Center http://depts.washington.edu/pfes/CultureClues.htm

Cultural Competency Learning Objectives

Homestead Schools, Inc. – Social Work

http://www.homesteadschools.com/LCSW/courses/CulturalCompetence/toc.html

Cultural Competency Toolkit for Broward County, Florida

The Coordinating Council of Broward Multicultural Board

http://www.broward.org/celebratingdiversity/ccbculturalcomptoolkit.pdf

Cultural Competence Works: Using Cultural Competence to Improve the Quality of Health Care for Diverse Populations and Add Value to Managed

Care Arrangements

Health Resources Services Administration, U.S. Department of Health and Human Services

ftp://ftp.hrsa.gov/financeMC/cultural-competence.pdf
1 1 8 U . S . A D M I N I S T R A T I O N O N A G I N G 

Cultural ComplementarityTM Model

Greater Twin Cities United Way

http://www.unitedwaytwincities.org/ourimpact/culturaldynamics_complementarity.cfm

Culture and Diversity Tip Sheet

Prevention by Design

http://socrates.berkeley.edu/~pbd/pdfs/Culture_Diversity.pdf

Cultural Competence Resources for Health Care Providers

Health Resources Services Administration, U.S. Department of Health and Human Services

http://www.hrsa.gov/culturalcompetence/

Curriculula Enhancement Module Series

National Center for Cultural Competence, Georgetown University Center for Child and Human Development 

http://www.nccccurricula.info/

Diversity and Equity

National Association of Social Workers

http://www.socialworkers.org/diversity/default.asp

Inclusiveness at Work: How to Build Inclusive Nonprofit Organizations

The Denver Foundation

http://www.nonprofitinclusiveness.org/inclusiveness-work-how-build-inclusive-nonprofit-organizations

Multicultural Toolkit: Toolkit for Cross-Cultural Collaboration

Awesome Library, Evaluation and Development Institute

http://www.awesomelibrary.org/multiculturaltoolkit.html 

National Center for Cultural Competence, Georgetown University

http://www11.georgetown.edu/research/gucchd/nccc

National Standards on Culturally and Linguistically Appropriate Services (CLAS)

The Office of Minority Health, U.S. Department of Health and Human Services 

http://www.omhrc.gov/templates/browse.aspx?lvl=2&lvlID=15

Network of Multicultural Aging (NOMA) 

An American Society on Aging Constituent Group 

http://www.asaging.org/networks/index.cfm?cg=NOMA

New Ventures in Leadership: A Leadership Program for Professionals of Color in Aging

American Society on Aging

http://www.asaging.org/nvl/index.cfm

The Office of Minority Health, U.S. Department of Health and Human Services

http://minorityhealth.hhs.gov/

Opening the Door to the Inclusion of Transgender People: The Nine Keys to Making Lesbian, Gay, Bisexual and Transgender Organizations Fully 

Transgender-Inclusive

National Gay and Lesbian Task Force Policy Institute and National Center for Transgender Equality

http://www.thetaskforce.org/downloads/reports/reports/opening_the_door.pdf

Note: Disclaimer from the U.S. Administration on Aging (AoA) 

Information presented in this document does not constitute an endorsement or recommendation by the U.S. Administration on Aging or any of 

its employees. The AoA is not responsible for the contents of any referenced Web page(s) and does not endorse any specific product or service 

provided by public or private organizations. The user takes full responsibility for accessing any of the referenced links.
 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 119

The Provider’s Guide to Quality & Culture

Management Sciences for Health

http://erc.msh.org/mainpage.cfm?file=1.0.htm&module=provider&language=English

Race, Ethnicity and Health Care 

Kaiser Foundation

http://www.kaiseredu.org/tutorials/REHealthcare/player.html

Standards for Cultural Competence in Social Work Practice

National Association of Social Workers 

http://www.socialworkers.org/practice/standards/NASWCulturalStandards.pdf 

Think Cultural Health: Bridging the Health Care Gap through Cultural Competency Continuing Education Programs

The Office of Minority Health, U.S. Department of Health and Human Services

http://www.thinkculturalhealth.org/

D _______________________________________________________________________________________________________________________________________________________________

Dementia/Alzheimer’s Disease

Alzheimer’s and Dementia Caregiver Resource Guide

Center for Aging and Diversity, Institute on Aging

The University of North Carolina at Chapel Hill

http://www.aging.unc.edu/cad/files/CaregiverResourceGuide2009.pdf

10 Steps to Providing Culturally Sensitive Dementia Care

The Washington DC Area Geriatric Education Center Consortium

http://wagecc.gwumc.edu/pdf/10Steps.pdf

Disability

Aging and Vision Loss Fact Sheet

The American Federation for the Blind

http://www.afb.org/seniorsite.asp?SectionID=68&TopicID=320&DocumentID=3374

Aging with Developmental Disabilities: Position Statement

Texas Council for Developmental Disabilities

http://www.txddc.state.tx.us/public_policy/position/aging.asp

Critical Elements of an Effective Drop-In Center Serving People with Psychiatric Disabilities 

Michigan Department of Community Health and Michigan State University

http://www.michigan.gov/documents/mdch/Critical_Elements_of_an_Effective_Dropin_Center_203778_7.pdf

Disability Etiquette

Easter Seals

http://www.easterseals.com/site/PageServer?pagename=ntl_etiquette

Disability Etiquette: Tips on Interacting with People with Disabilities

United Spinal Association

http://www.unitedspinal.org/pdf/DisabilityEtiquette.pdf
1 2 0 U . S . A D M I N I S T R A T I O N O N A G I N G 

Enhancing Your Interactions with People with Disabilities

Public Interest Directorate of the American Psychological Association 

http://www.apa.org/pi/disability/enhancehome.html

Guidelines for Reporting and Writing about People with Disabilities

Research and Training Center on Independent Living

University of Kansas 

http://www.apastyle.org/manual/related/guidelines-reporting-and-writing.pdf

National Council on Disability

http://www.ncd.gov/

The National Council on Independent Living 

http://www.ncil.org/

Network on Environments, Services and Technologies for Maximizing Independence (NEST) 

An American Society on Aging Constituent Group 

http://www.asaging.org/networks/index.cfm?cg=NEST

Parallels in Time I & II: A History of Developmental Disabilities

Minnesota Governor’s Council on Disabilities

http://www.mncdd.org/parallels/index.html

http://www.mncdd.org/parallels2/index.htm

State Resource Locator

Office on Disability, U.S. Department of Health and Human Services

http://www.hhs.gov/od/topics/Resource%20Locator/resourcelocator.html

Understanding Disabilities in American Indian and Alaska Native Communities: Toolkit Guide

National Council on Disability 

http://www.ncd.gov/newsroom/publications/2003/native_toolkit.htm

Vision Loss

Family Caregiver Alliance, National Center of Caregiving

http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=2222

E _______________________________________________________________________________________________________________________________________________________________

English as a Second Language (ESL)

Guiding Values and Principles for Language Access

National Center for Cultural Competence, Georgetown University

http://www11.georgetown.edu/research/gucchd/nccc/foundations/frameworks.html#lcprinciples

Health Materials in Languages Other than English

http://macmla.org/sdu/handouts/coughlan_non_eng.pdf 

Limited English Proficiency

A Federal Interagency Website

http://www.lep.gov/

Note: Disclaimer from the U.S. Administration on Aging (AoA) 

Information presented in this document does not constitute an endorsement or recommendation by the U.S. Administration on Aging or any of 

its employees. The AoA is not responsible for the contents of any referenced Web page(s) and does not endorse any specific product or service 

provided by public or private organizations. The user takes full responsibility for accessing any of the referenced links.
 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 121

National Council on Interpreting in Health Care

www.ncihc.org

National Standards on Culturally and Linguistically Appropriate Services (CLAS) 

The Office of Minority Health, U.S. Department of Health and Human Services

http://www.omhrc.gov/templates/browse.aspx?lvl=2&lvlID=15

H _______________________________________________________________________________________________________________________________________________________________

Health Disparities and Minority Health

Cultural Competence in Health Care

Chronic Diseases Issue Brief

Center on an Aging Society, Georgetown University

http://ihcrp.georgetown.edu/agingsociety/pdfs/cultural.pdf

Estimating the Cost of Racial and Ethnic Health Disparities

The Urban Institute

http://www.urban.org/uploadedpdf/411962_health_disparities.pdf

Information for Selected Audiences

National Heart Lung and Blood Institute, 

National Institutes of Health, U.S. Department of Health and Human Services

http://www.nhlbi.nih.gov/health/pubs/pub_slctpro.htm#afam

Daily Health Policy Report

Kaiser Health News

http://www.kaiserhealthnews.org/Daily-Report.aspx

Making the Grade on Women’s Health: A National and State-by-State Report Card

National Women’s Law Center

http://www.nwlc.org/details.cfm?id=1861§ion=health

Office of Minority and Women’s Health 

National Center for Preparedness, Detection and Control of Infectious Diseases, Centers for Disease Control and Prevention, U.S. Department of 

Health and Human Services

http://www.cdc.gov/ncidod/omwh/

Racial and Ethnic Disparities in U.S. Health Care: A Chartbook

The Commonwealth Fund

http://www.commonwealthfund.org/Content/Publications/Chartbooks/2008/Mar/Racial-and-Ethnic-Disparities-in-U-S--Health-Care--AChartbook.aspx

Rural Health Disparities

Rural Assistance Center, School of Medicine and Health Science, University of North Dakota 

http://www.raconline.org/info_guides/disparities/

Regional and State Activities

National Partnership for Action to End Health Disparities, Office of Minority Health, U.S. Department of Health and Human Services

http://minorityhealth.hhs.gov/npa/templates/browse.aspx?lvl=2&lvlid=5
1 2 2 U . S . A D M I N I S T R A T I O N O N A G I N G 

State Offices of Minority and Multicultural Health Liaison Map 

Office of Minority Health, U.S. Department of Health and Human Services

http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid=187

U.S. Department of Health and Human Services

http://www.ahrq.gov/research/minorix.htm

Health Literacy

Quick Guide to Health Literacy and Older Adults

Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services

http://www.health.gov/communication/literacy/olderadults/literacy.htm

Hispanic/Latino American

Healthy Minds. Healthy Lives. 

Latinos and Mental Health

American Psychiatric Association

http://healthyminds.org/More-Info-For/HispanicsLatinos.aspx

Latino Programs

American Diabetes Association

http://www.diabetes.org/community-events/programs/latino-programs/

Mental Health: A Report of the Surgeon General

Chapter 6: Mental Health Care for Hispanic Americans

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services

http://mentalhealth.samhsa.gov/cre/ch6.asp

A Primer for Cultural Proficiency: Towards Quality Health Services for Hispanics

The National Alliance for Hispanic Health

http://www.hispanichealth.arizona.edu/Primer%20for%20Culural%20Proficiency%20NAHH.pdf

National Hispanic Council on Aging

http://www.nhcoa.org/

Serving Hispanic Families: Home and Community-Based Services for People with Dementia and Their Caregivers

Alzheimer’s Association 

http://www.aoa.gov/AoARoot/AoA_Programs/HCLTC/Alz_Grants/docs/Toolkit_6_Serving_Hispanic_Families.pdf

HIV/AIDS

The Aging of HIV

National Association of Social Workers

http://www.socialworkers.org/practice/hiv_aids/AgingOfHIVFactSheet.pdf

Elderly and HIV

National Prevention Information Network, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services

http://cdcnpin.org/scripts/population/elderly.asp

HIV-Associated Dementia

Family Caregiver Alliance, National Center on Caregiving 

http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=1107

Note: Disclaimer from the U.S. Administration on Aging (AoA) 

Information presented in this document does not constitute an endorsement or recommendation by the U.S. Administration on Aging or any of 

its employees. The AoA is not responsible for the contents of any referenced Web page(s) and does not endorse any specific product or service 

provided by public or private organizations. The user takes full responsibility for accessing any of the referenced links.
 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 123

Research on Older Adults with HIV

AIDS Community Research Initiative of America

http://acria.org/clinical/roah_05_05_08_final.pdf

Persons Aged 50 and Older: Prevention Challenges

Centers for Disease Control and Prevention, U.S. Department of Health and Human Services

http://www.cdc.gov/hiv/topics/over50/print/challenges.htm

What Are HIV Prevention Needs of Adults Over 50?

Center for AIDS Prevention Studies, University of California, San Francisco

http://www.caps.ucsf.edu/pubs/FS/over50.php

Homeless

Homeless and Elderly: Understanding the Special Health Care Needs of Elderly Persons Who Are Homeless

Health Resources and Services Administration, U.S. Department of Health and Human Services 

http://bphc.hrsa.gov/policy/pal0303.htm

Homeless Policy Academies: Improving Access to Mainstream Services for People Experiencing Homelessness 

Health Resources and Services Administration, U.S. Department of Health and Human Services

http://www.hrsa.gov/homeless/state/index.htm

Homelessness Among Elderly Persons

National Coalition for the Homeless

http://www.nationalhomeless.org/factsheets/elderly.html

Outreach to People Experiencing Homelessness: A Curriculum for Training Health Care for the Homeless Outreach Workers

Health Resources and Services Administration, U.S. Department of Health and Human Services

http://www.nhchc.org/Curriculum/module2/module2D/module2d.htm

I _______________________________________________________________________________________________________________________________________________________________

Immigrant 

A Guide for Providers: Engaging Immigrant Seniors in Community Service and Employment Programs

Senior Service America and the Center for Applied Linguistics 

http://www.seniorserviceamerica.org/news/cal_guide.html

U.S. Committee for Refugees and Immigrants

http://www.refugees.org/article.aspx?id=2080&subm=178&area=Participate&

L _______________________________________________________________________________________________________________________________________________________________

Legal

Americans’ Diversity Guide

Chapter 4: Laws, Executive Orders, and Standards

National Association of State Units on Aging

http://www.nasua.org/issues/tech_assist_resources/national_aging_ir_support_ctr/diversity_guide/diversitychapter4.html
1 2 4 U . S . A D M I N I S T R A T I O N O N A G I N G 

Cultural Competency Legislation

Think Cultural Health: Bridging the Health Care Gap through Cultural Competency Continuing Education Programs 

The Office of Minority Health, U.S. Department of Health and Human Services

https://www.thinkculturalhealth.org/cc_legislation.asp

Durable Powers of Attorney and Revocable Living Trusts

Family Caregiver Alliance, National Center on Caregiving

http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=434

Legal Information & Resources

National Center for Lesbian Rights

http://www.nclrights.org/site/PageServer?pagename=legal_getHelp

Legal Issues for LGBT Caregivers

Family Caregiver Alliance, National Center on Caregiving

http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=436

Legal Issues in Planning for Incapacity

Family Caregiver Alliance, National Center on Caregiving

http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=437

LGBT Elder Law: Toward Equity In Aging

Harvard Journal of Law and Gender

http://www.law.harvard.edu/students/orgs/jlg/vol321/1-58.pdf

Protective Proceedings: Guardianships and Conservatorships

Family Caregiver Alliance, National Center on Caregiving 

http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=431

Lesbian, Gay, Bisexual and Transgender (LGBT)

Community Standards of Practice for the Provision of Quality Health Care Services to Lesbian, Gay, Bisexual, and Transgender Clients

Gay, Lesbian, Bisexual and Transgender Health Access Project

http://www.glbthealth.org/CommunityStandardsofPractice.htm

Do We Intend to Keep this Closeted? 

Edward H. Thompson, Jr., The Gerontologists

http://gerontologist.gerontologyjournals.org/cgi/content/full/48/1/130

Is Your Area Agency on Aging LGBT Friendly?

SageConnect 

http://sageconnect.net/intranet/pops/pop_print.cfm?pop=61

Is Your “T” Written in Disappearing Ink? A Checklist for Transgender Inclusion 

FORGE & Transgender Aging Network

http://www.forge-forward.org/handouts/InclusionChecklist.pdf

Lesbian, Bisexual and Transgender Female Elders

National Gay and Lesbian Task Force

http://www.thetaskforce.org/downloads/misc/LBTFemaleEldersFactSheet.pdf

Note: Disclaimer from the U.S. Administration on Aging (AoA) 

Information presented in this document does not constitute an endorsement or recommendation by the U.S. Administration on Aging or any of 

its employees. The AoA is not responsible for the contents of any referenced Web page(s) and does not endorse any specific product or service 

provided by public or private organizations. The user takes full responsibility for accessing any of the referenced links.
 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 125

Lesbian, Gay, Bisexual and Transgender Elders

Aging Times, National Center for Gerontological Social Work Education

http://depts.washington.edu/geroctr/AT/2_3/lgbt.html

Lesbian, Gay Male, Bisexual and Transgendered Elders: Elder Abuse and Neglect Issues

FORGE and Transgender Aging Network

http://www.forge-forward.org/handouts/tgelderabuse-neglect.html

LGBT Aging Issues Network (LAIN) 

An American Society on Aging Constituent Group 

www.asaging.org/lgain

LGBT Caregiving: Frequently Asked Questions

Family Caregiver Alliance, National Center on Caregiving

http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=409

Make Room for All: Diversity, Cultural Competency and Discrimination in an Aging America

National Gay and Lesbian Task Force

http://www.thetaskforce.org/reports_and_research/make_room_for_all

Module for Human Behavior and Social Environment Sequence

Diversity and Older Adults: Gay Men and Lesbians

Council on Social Work Education, California State University, Long Beach

http://depts.washington.edu/geroctr/Curriculum3/TeachingModule/HBSE_DiversityModule.doc

National Gay and Lesbian Task Force

http://thetaskforce.org/

Outing Age: Public Policy Issues Affecting Gay, Lesbian, Bisexual and Transgender Elders 

National Gay and Lesbian Task Force

http://www.thetaskforce.org/reports_and_research/outing_age

Raising Issues: Lesbian, Gay, Bisexual, & Transgender People Receiving Services in the Public Mental Health System 

Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services

http://www.nami.org/Template.cfm?Section=Multicultural_Support1&Template=/ContentManagement/ContentDisplay.cfm&ContentID=28246

Services and Advocacy for Gay, Lesbian, Bisexual & Transgender Elders 

http://www.sageusa.org/index.cfm

State and Local Directory of LGBT Advocacy and Service Organizations

National Gay and Lesbian Task Force

http://www.thetaskforce.org/activist_center/act_locally

Transforming Mental Health Services for Older People: Lesbian, Gay, Bisexual and Transgender (LGBT) Challenges and Opportunities

FORGE & Transgender Aging Network

http://www.forge-forward.org/handouts/AARP_tranformingMH.pdf
1 2 6 U . S . A D M I N I S T R A T I O N O N A G I N G 

Transgender Elders and SOFFAs: A Primer for Service Providers and Advocates

FORGE & Transgender Aging Network

http://www.forge-forward.org/handouts/TransEldersSOFFAs-web.pdf

Transgender Elder Health Issues

FORGE & Transgender Aging Network

http://www.forge-forward.org/handouts/transelderhealth.pdf

27 Practical Suggestions to Make Your Organization More GLBT Friendly 

Benchmark Institute 

http://www.benchmarkinstitute.org/GLBT/27.htm

M _______________________________________________________________________________________________________________________________________________________________

Mental Health

Culture, Race, and Ethnicity

Mental Health: A Report of the Surgeon General

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services

http://mentalhealth.samhsa.gov/cre/toc.asp

Elderly Suicide Fact Sheet

American Association of Suicidology

http://www.suicidology.org/c/document_library/get_file?folderId=232&name=DLFE-158.pdf

Depression and Suicide in Older Adults Resource Guide

Office on Aging, American Psychological Association 

http://www.apa.org/pi/aging/depression.html

Mental Health and Aging Network (MHAN) 

An American Society on Aging Constituent Group 

http://www.asaging.org/networks/index.cfm?cg=MHAN

Promoting Older Adult Health: Aging Network Partnerships to Address Medication, Alcohol, and Mental Health Problems

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services

https://www.ncoa.org/Downloads/PromotingOlderAdultHealth.pdf

P _______________________________________________________________________________________________________________________________________________________________

Previously Incarcerated Persons (PIPS)

One in 100: Behind Bars in America 2008

The Pew Center on the States

http://www.pewcenteronthestates.org/uploadedFiles/8015PCTS_Prison08_FINAL_2-1-1_FORWEB.pdf

Note: Disclaimer from the U.S. Administration on Aging (AoA) 

Information presented in this document does not constitute an endorsement or recommendation by the U.S. Administration on Aging or any of 

its employees. The AoA is not responsible for the contents of any referenced Web page(s) and does not endorse any specific product or service 

provided by public or private organizations. The user takes full responsibility for accessing any of the referenced links.
 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

R _______________________________________________________________________________________________________________________________________________________________

Religion and Spirituality

Body/Mind/Spirit: Toward a Biopsychosocial-Spiritual Model of Health 

National Center for Cultural Competence, Georgetown University 

http://www11.georgetown.edu/research/gucchd/nccc/body_mind_spirit/index.html

Forum on Religion, Spirituality and Aging 

An American Society on Aging Constituent Group 

http://www.asaging.org/networks/index.cfm?cg=FORSA

Integrating Spirituality into Social Work Practice: The Reflections on Spirituality and Aging (ROSA) Model

Council on Social Work Education, School of Social Service, Saint Louis University 

http://depts.washington.edu/geroctr/Curriculum3/TeachingModule/Spirituality_ROSAModule.doc

Rural

National Rural Health Association

http://www.ruralhealthweb.org/

Rural Assistance Center 

Center for Rural Health, School of Medicine and Health Science, University of North Dakota

Rural Policy and Research Institute

http://www.raconline.org/

P _______________________________________________________________________________________________________________________________________________________________

Substance Abuse

Promoting Older Adult Health: Aging Network Partnerships to Address Medication, Alcohol, and Mental Health Problems

Substance Abuse and Mental Health Administration, U.S. Department of Health and Human Services 

https://www.ncoa.org/Downloads/PromotingOlderAdultHealth.pdf

Substance Abuse and Mental Health Among Older Americans: The State of the Knowledge and Future Directions

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services

http://www.samhsa.gov/OlderAdultsTAC/SA_MH_%20AmongOlderAdultsfinal102105.pdf

V _______________________________________________________________________________________________________________________________________________________________

Veterans

Center for Minority Veterans

U.S. Department of Veterans Affairs

http://www1.va.gov/centerforminorityveterans/
1 2 8 U . S . A D M I N I S T R A T I O N O N A G I N G 

A p e d i x H D I V E R S I T

T R A I N I N G T I P S

The list of training tips presented in this appendix represents a starting point for users of this Toolkit. Agency staff 

and 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 this 

toolkit. 

Establish Training Policies Up Front

Ideally, the facilitator should take at least five minutes 

to ask participants what type of guidelines the group 

should establish for creating both a productive and 

respectful learning environment. The goal is not to 

create a list of rules, but to establish a few guidelines 

that foster learning. After the facilitator and participants 

create the list of guidelines, they should post the list in 

a visible place where everyone can periodically review 

the guidelines during the training session. 

Neutralize the Discussion

It is important that a facilitator remain neutral about 

issues, so the participant group does not perceive any 

bias in the training. If the participant group perceives 

that a facilitator is biased or has strong preferences 

for certain groups or ideas (whether political, social, 

religious, or cultural), the facilitator risks losing 

credibility with the participant group.

Asking open-ended questions allows the facilitator 

to appear neutral and without judgment toward 

participants. Often, closed questions “couch” or imply 

a position on or attitude about a topic. Asking openended questions helps to neutralize the discussion and 

creates an environment in which the participants model 

the behavior of the facilitator.

It is important to understand that the act of judging 

can be both a covert and an overt behavior. A facilitator 

should be careful about facial expressions and eye 

contact when participants respond. The facilitator 

should maintain an open, pleasant disposition when 

the participants voice opinions. Both verbal and nonverbal behavior should be neutral. 
 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 129

Avoid “Touchy Feely” Statements

Participants may assume that diversity training sessions 

include some level of “touchy feely” activity. Sometimes 

indicating up front that this will not be a touchy feely 

training session can immediately put some at ease. Let 

the participants know that sharing experiences is a very 

valuable learning tool and that it is okay to share. But 

for those who do not want to, that is okay too. 

Acknowledge “Ouch Moments”

Not all topics about diversity are easy to discuss. A 

participant might express that he/she believes some 

viewpoints are insensitive and even offensive. This is 

an “ouch moment.” When a participant shares with the 

group that he/she perceives a particular viewpoint to be 

insensitive, the facilitator should simply acknowledge 

and thank the participant for his/her contribution 

without validating the participant’s position. There are 

two reasons for doing this: (1) it demonstrates that the 

facilitator is not apprehensive or uncomfortable about 

addressing issues that may be controversial, and (2) 

because the facilitator is not apprehensive, his/her 

credibility can be enhanced with the participant group. 

Do not dwell on the ouch moment; that could sidetrack 
1 3 0 U . S . A D M I N I S T R A T I O N O N A G I N G 

the training. Simply thank and acknowledge the 

participant for sharing his or her viewpoint and make 

the participant group aware of varying perspectives 

without minimizing the statement that was shared. 

Ask Both Open-Ended and Leading Questions

One of the indicators of participant learning is the 

learner’s ability to question and engage in self-reflection. 

A facilitator can initiate this self-reflective process by 

asking both open-ended and closed questions. Openended questions are less confrontational and are 

designed to encourage a learner to think about different 

perspectives. For example: “What are your general 

feelings about differences?” This question permits the 

participant to provide a broad range of responses. 

Therefore, it may not be perceived as confrontational. 

Leading questions may be perceived as confrontational 

because they are direct. For example: “How did 

you feel when your outreach efforts to a particular 

community weren’t successful?” Because this question 

leads the respondent to a specific answer, it may be 

perceived as being controversial. Both open-ended 

and closed questions have their learning benefits 

and disadvantages. It’s up to the facilitator to choose 

carefully which to use in a given situation. 

Checking-In

Checking-in provides a way to monitor both the group’s 

and each individual’s attitudes and feelings, and can 

offer the opportunity for the facilitator to adjust the 

training strategy. It can also indicate when a break in 

the training is needed to accommodate the mood or 

tempo of the class. 

A facilitator may check-in by asking the participant 

group, “Does everyone feel okay?” If the facilitator 

chooses to use the check-in strategy, guidelines 

should be established for its use up front. If the 

facilitator does not set guidelines, the check-in could 

provide an opportunity for participants to openly 

vent disagreement or frustration and jeopardize the 

momentum of the participant group’s learning. Be sure 

to gently express that checking-in does not require 

disclosure regarding why a participant is or is not 

feeling comfortable. 

Schedule Breaks 

Breaks provide excellent opportunities for the 

participants to talk casually about what they have 

learned, or to take time to self-reflect or journal. 

Providing breaks often helps individual participants to 

self-manage their emotions and attitudes during the 

training. 

 

Encourage Journaling

Journaling is the process of allowing quiet reflection 

time for individual participants to note feelings, 

attitudes, and viewpoints during the training session. 

Journaling also permits an individual to share feelings 

in a confidential and comfortable way. This strategy 

works particularly well for people who may feel 

uncomfortable sharing their thoughts with the other 

participants.

Establish a Learning Wall

A facilitator can preserve learning or “aha” moments 

by having the participants document their responses 

to activities on easel paper, and then posting some of 
 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

the most important responses in a visible area of the 

training room. The participants can review previous 

concepts and reflect on discussions and lessons learned 

more easily when these points are posted on the wall.

Icebreakers and Energizers

Icebreakers have traditionally been used at the 

beginning of training sessions to help participants 

get to know each other. This is important because 

it is difficult for people to share experiences with 

strangers. Facilitators soon learn that a well thought-out 

icebreaker will often enliven participants’ interests and 

enhance learning. 

Icebreakers in the middle of a training session are 

called energizers. Facilitators should consider using 

energizers to control and lighten the mood or tempo of 

a training session. Facilitators can also use energizers 

as transitional strategies to move the participant group 

back into a learning mode following lunch and breaks. 

Ask for Reporting Out

Facilitators may ask a learner from each group to 

summarize what he/she has learned from the lesson. 

Reporting out can help clarify the findings of groups, 

build consensus, and reveal differing perceptions and 

conclusions.

Pass the Ball

Sometimes a facilitator will experience a participant 

group that is extremely talkative to the point that 

frequent interruptions occur in the discussion. One 

way to control a group’s conversation is to pick a 

small object (a ball, a toy, or a small action figure) that 

represents a turn to talk. When an individual finishes 

talking, he/she passes the object to another member 

of the group. Everyone should make an effort to pass 

the object to a person who has not previously had 

the opportunity to share thoughts. This ensures that 

participants with quiet personalities get an opportunity 

to voice their thoughts too. 

Collect Anonymous Lessons Learned

Some participants may want to share their insights 

anonymously. Such insights can sometimes help 

reveal difficult topics in a non-threatening way. Sharing 

anonymously also allows the participants to take 

responsibility for the “elephant in the room” and 

enable the group to acknowledge a difficult topic with 

respect and without controversy. 

Thank Participants

Sometimes it takes a lot of courage for a participant to 

share what was learned. When anyone contributes to the 

conversation, particularly when a personal experience 

was shared, facilitators should thank the participant for 

contributing.