The National Association of Protection and Advocacy Systems has published the following newsletter and literature review on multicultural outreach to people with disabilities. ---------- P&A NEWS Special Edition on Multiculturalism P&As provide legally-based advocacy services to people with disabilities. Protection & Advocacy (P&A) Systems News; Vol. 2 Issue 3 Summer 1997 Advocacy Training/Technical Assistance Center (ATTAC)* National Association of Protection & Advocacy Systems (NAPAS) WHAT'S IN A WORD? ac-cul-tu-ra-tion n. 1. the process of conditioning a child to the patterns or customs of a culture. 2. the process of becoming adapted to a new or different culture with more or less advanced patterns. 3. the mutual influence of different cultures in close contact. ad-vo-ca-cy n. the act of advocating, or speaking or writing in support (of something) com-pe-tence n. 1. sufficient means for a modest livelihood. 2. condition or quality of being competent; ability; fitness; specif., legal capability, power, or jurisdiction. cul-tur-al adj. 1.of or pertaining to culture, specif., of the training and refinement of the mind, interests, tastes, skills, arts, etc. di-ver-si-ty pl. 1. quality, state, fact or instance of being diverse; difference. 2. variety. in-clu-sion n. 1. an including or being included 2. something included; specif. mul-ti a combining form meaning: 1. having, consisting of, or affecting many. 2. more than two (or sometimes one). 3. many times more than. PLENTY.... *ATTAC is a federal interagency project of the Administration on Developmental Disabilities, Center for Mental Health Services and Rehabilitation Services Administration. An Advocates Guide to Multiculturalism\1\ Society has the responsibility of providing the most effective treatment, care and protection of rights to individuals diagnosed with a mental illness. However, complaints of abuse, neglect, and rights violations against mental health professionals surface daily from people residing in psychiatric institutions. Advocates are in place because individuals responsible for ensuring client rights are not violated have abdicated their duty. For most of these vulnerable individuals, we are their last resort. For this reason, we must not abdicate our responsibility to comprehensively serve our clients to the best of our ability. As far as multicultural barriers, an advocate must go the extra mile to understand the intricacies of their client's cultural framework and develop intervention strategies that reinforce or create supportive services of inclusion. The minority culture should not be compared to the majority culture. Comparison implies insufficiences and inadequacies. Cultural awareness suggests consciousness of a particular issue. To recognize the value in aperson's culture, is to affirm the relevance of that individual. Read everything you can find, talk to people who know the culture, become involved, and ask questions. Your search will provide understanding beyond that available in any case note. There are four major nonwhite ethnic groups represented in our society: Latin-Americans, African-Americans, Asian-Americans and Native- Americans. Of these four, African- Americans and Latin-Americans, in most instances, are believed to be the minority groups most likely to be represented in the mental health system today. In casework, an advocate must consider how his or her client's culture was instrumental in shaping and developing his/her frame of reference. On the back page of this newsletter, you will find an outline of a few factors that are important to consider when working with individuals from varying ethnic groups. In the text of the newsletter, you will find an overview of P&A work in multiculturalism and general tips about communicating with different cultures. L. Elaine Sutton Mbionwu Mental Health Advocate Georgia Advocacy Office "The world is constantly changing and becoming culturally competent is a journey, not a destination," National Resource Center for Youth Services. Cultural Competence ATTAC held two conferences -- one in January '97 and one in April '97 -- that included criteria on how to respond to cultural differences. The tracks provided participants with interviewing skills to help them respond to the needs of people with disabilities who are from different cultures. Following are tips taken from the conference: How do you determine if your organization is culturally competent? Cultural competence is a set of congruent practice skills, attitudes, policies and structures, which come together in a system agency, or among professionals and enable that system, agency or those professionals to work effectively in the context of cultural differences. "Cultural Competence means knowing the people you serve, how they differ from you and from each other and how that affects what they accept from you," National Resource Center for Youth Services. Five Elements of a Culturally Competent Agency: 1) Values diversity by accepting that people it serves are from different backgrounds and will make different choices based on cultures; 2) Assesses its sense of culture by recognizing that the agency is shaped by its own culture and how it interfaces with other cultures; 3) Accepts the dynamics of difference and recognizes that culturally prescribed patterns of communications, etiquette and problem solving often result in misjudgements and misinterpretations; 4) Incorporates cultural knowledge into all levels of service delivery and 5) Adapts to diversity by building a context for a cross-culturally and disability acceptance. P&A Work in Multiculturalism "People with disabilities should receive services that are easily accessible and culturally competent," Outcome Measures, ATTAC of NAPAS 1997. P&A Cases The Texas P&A advocated on behalf of a client who is monolingual in Spanish and a resident at an inpatient facility. Prior to the P&As intervention, the client was unable to access an interpreter. After negotiations with the P&A, the state facility changed their policies to assure the provision of interpreters to accommodate the needs of clients in all critical instances. In California, the P&A represented a monolingual Vietnamese woman who was institutionalized for years following an incident with the police. The woman, who fled Vietnam as a boat person and endured unspeakable horrors in her voyage, was placed in a mental institution. Police arrived at the woman's home after neighbors complained that she was creating a disturbance. Upon arrival, the police burst into her apartment and yelled at her in English to drop the kitchen knife she was holding. The woman did not understand the commands and did not drop the knife, so the police shot her in the arm andarrested her. She spent several years in a state hospital where no staff spoke Vietnamese. When the P&A became involved, they convinced the state to transfer the woman to a state hospital with Vietnamese-speaking staff. A year later she was given outpatient status on a conditional release program. Subsequently, with the aid of the P&A, a superior court restored the client to sanity status and unconditionally released her from commitment. The P&A also held a self-advocacy training for people of Japanese descent. The session focussed on housing issues. In Japan, even if housing were a legal right, demanding one's rights would not be appropriate. Through role play, the group found culturally appropriate ways to ask for and get what they need. The training highlighted the importance of cultural sensitivity and creativity in dealing with diverse cultures and legal systems. In Connecticut, the P&A represented a 39-year-old woman with mental retardation after she failed the naturalization test. The woman lived as a permanent legal resident for 26 years. She was denied citizenship because she could not understand the form of the U.S. government or the oath of allegiance. Even after Congress amended the Immigration Act to waive testing requirements for persons with developmental disabilities, the woman was still denied citizenship. The P&A filed a lawsuit citing violations of the Rehabilitation Act and the Fifth Amendment right to due process and equal protection. After a one day trial,the court found that the client understood the basic principles of right and wrong -- good and bad. The court made oral findings from the bench and naturalized the woman immediately. In Massachusetts, the P&A intervened at a state hospital for people with psychiatric disabilities that was not providing appropriate translation services for Spanish-speaking patients. The P&A found that the hospital did not offer programs or services in Spanish, that no clinicians were fluent in Spanish and on at least one occasion, a Spanish-speaking maintenance worker was solicited by the treatment team to explain a patient's medication regimen to that patient. The P&A raised these issues with the hospital's chief operating officer who has implemented a task force to address the issue of protocol for interpreter services. To date, no progress has been made and the P&A maintains a careful watch. In New York, the P&A successfully concluded a lawsuit which was brought on behalf of all patients who spoke only or primarily Spanish at Rockland Psychiatric Center. The lawsuit was brought after it was learned that these patients, who were unable to communicate in or understand English, were being confined for treatment when the treatment team was unable to effectively communicate with them. A settlement agreement was reached between the parties which resulted in the creation of a second Spanish speaking treatment unit at Bronx Psychiatric Center. The patients whomoved to the Bronx Center have done well -- one patient is expected to be discharged in the near future. By the year 2000 minorities, women and immigrants will compose 85 percent of the growth in the workforce. Cultural Diversity and Rehabilitation Training Guide, 10/94. In Georgia, the P&A assisted a social worker who was trying to place a 35- year-old Asian-American, who has spent the past four years in a mental health facility, into the community. The client is originally from Vietnam and spent 18 months in a refugee camp where he was subjected to torture and separated from his immediate family. The P&A used their experience to look through the layers of this situation. For example, they started with the client's records which included a diagnosis of Post Traumatic Stress Disorder (PTSD). The PTSD relates to his experience in the refugee camp. The client had been deemed violent. This violence occurred when he was put in restraints and secluded. The P&A pointed out that knowing the client's history should have predicted that he would become violent in that situation. His treatment plan included participation in group sessions. This participation would be useless unless an interpreter is used. According to the P&A, "The affects of not meeting the needs of minority clients are numerous. To name a few, they include but are not limited to: nonresponsiveness to treatment, multiple repeat visits to psychiatric facilities, upon discharge decompensation at a rapid rate and decreased ability to access outpatient services." The National Organization on Disability states that less than 10 percent of minority people with disabilities know about the Americans with Disabilities Act (ADA). The Kentucky P&A observed that there was a disproportional number (2-3 times greater) of African-Americans on locked or violent wards in psychiatric institutions. For example, in 1993 at Central State Hospital, 63% of the people placed in a locked ward were African-American. In the setting overall, 32% were African-American. The P&A saw this injustice and set out to remedy the situation. They set as their goal that the numbers of African- Americans on selected wards equal those in the general hospital population. In 1994, the P&A proposed a correction plan to the state's Department of Mental Health and Mental Retardation. This plan included training in cultural sensitivity, review process for determination of ward placement, recruitment of minority mental health professionals and to create a culturally diverse review team. In 1997, at Central State Hospital, 40% of people in locked wards are African- American and 41% of people in the setting overall are African-American. That statistic illustrates the P&As goal that African-Americans are not disproportionately place in locked wards was achieved. Ability +Diversity=Economic Strength President's Committee on Employment of People with Disabilities, 1994 Conference. P&As Receive Awards that Honor their Commitment to Diversity " Disability is a natural part of the human experience found within every culture and minority faction throughout the globe," Iowa P&A The Iowa P&A received the Iowa Lieutenant Governor's Committee on Diversity 1996 Prism Award. The award highlights the work of communities, organizations, groups and individuals who have demonstrated exemplaryefforts towards the elimination of discrimination and the celebration of diversity. The award letter stated, "Your diversity plan is to be highly commended for the outstanding contribution you are making to the valuing of diversity in the state." The Iowa P&A also staffs the Lt. Governor's Committee on Diversity booth at the Iowa State Fair. This year, approximately 600 people stopped by their booth and received information about diversity in Iowa. P&As Diversity Award The Multicultural Committee of the National Association of Protection & Advocacy Systems (NAPAS) established criteria for a diversity achievement award within the network. Criteria included staff development on issues of diversity/cultural competency, program development and the establishment of collaborative relationships with disability and non- disability community-based and or civil rights organizations. The award was presented during NAPAS' 20th Annual Conference in May, 1997 to the California P&A, Protection & Advocacy, Inc. (PAI), for their comprehensive efforts toward becoming a more culturally competent and disability diverse agency. PAI was also named Agency of the Year by Fiesta Educativa for their dedication in working with Spanish-speaking consumers and family members. "People with disabilities have always been excluded from the bounty of our nation's resources. Minorities with disabilities, in particular, have been the most disenfranchised of the disenfranchised. It is time that we bring them into the fold as full, first-class participants in our society." Hon. Rev. Jesse L. Jackson National Rainbow Coalition. Outreach to Arab Americans P&A Initiative The Michigan P&A received a grant to conduct outreach efforts to Arab American communities. The grant, which provided $5,000 during FY 96, was from Rehabilitation Services Administration (RSA) and funneled through ATTAC. The P&A continues an on-going communications with both of the major groups of Arab-Americans in the Detroit area. The two groups are the Arab Community Center for Economic and Social Services (ACCESS) and the Chaldean Federation. People who belong to ACCESS are mostly Muslim and people at the Federation are mostly Christian. The P&A found that the following tips while reaching out to this population: 1) Identify people in the community who have already started reaching out for assistance and 2) Pay attention to the cultural issues and read up on the issues which faced this population in their home countries. Following is an excerpt from Dismantling Cultural Barriers: Caring for Patients of the Muslim Faith by Melanie Robertson, University of Alberta: Patients don't bring just their health insurance cards to the hospital, but their whole past as well, including their cultural beliefs about their health. In public, all questions are answered and decisions are taken by the male even if the wife is the patient. Nurses need to be aware that therapeutic touch may not be appropriate. There is a cultural shyness about the body and these patients may feel invaded when touched by a person who is not related. Outreach to Asian Americans P&A Initiatives As with Michigan, the California and Louisiana P&As also received RSA grants to conduct outreach efforts to under served communities. Their grants were to Asian American communities in their states. Below is a summary of their findings: California The P&A has a longstanding involvement in reaching out to the Asian American community. Through this grant and other resources, they hired an Asian Pacific outreach coordinator who built on their strong foundation. The P&A raised awareness of their services by becoming a presence at community events. For example, the P&A had information booths at major Asian/Pacific Islander events, attended monthly Asian Pacific Islander Network meetings and Refugee Forum meetings, held trainings and networked closely with key individuals in leading organizations. The P&A found that the best way to understand the needs of the community is to attend the above mentioned community-based networking meetings. In addition, the P&A discovered that questionnaires asking community needs were useful when completed following a P&A training -- they did not receive the desired outcome when they were just mailed. Outreach materials that the P&A developed includes their brochure in Thai and Lao, Sacramento area community contact list, and a letter of introduction to gatekeepers and other primary contacts within the community. Louisiana The P&A used the grant to break into previously unchartered territory. Since 45% of the 41,000+ Asian Americans living in Louisiana are Vietnamese Americans, the P&A focused their efforts on this population. The P&A found that the most successful point of entry into the Vietnamese community was the Catholic Church. Generally speaking, they discovered that most people in this community would go to their local priests to discuss problems and ask for help. The local priest is the leader of the community and has the loyalty and trust of its members. Usually, people do not go outside of their own communities, This is based on their historical background resulting in a strong distrust of government and outsiders, the law and lawyers. The P&A built a working relationship with the Catholic priest who has expressed his willingness to inform the community about the P&A services. The P&A will continue to build on this relationship and possibly use Vietnamese outlets to advertise their services. Tips for Communicating with Asians and Southeast Asians: 1. If using a translator, do not use a child; 2. Consider the perception of person/family member with a disability; 3. Humility, modesty; 4. Authority, hierarchy; 5. Present physical symptoms rather than feelings. Communication Patterns Indirect communication, non- confrontational, avoid offending others and silence does not mean agreement, acquiescence or ignorance. Outreach to Alaskan Natives/Native Americans Tips for Working with a person who is an Alaskan Native 1) Alaskan Natives are a non-verbal culture. This stems from a belief that talking too much weakens one spiritually and the spirits around the person. Questions asked to Alaskan Natives should be as helpful as possible. 2) Alaskan Natives often hold back what they consider gory details or things that offend their sensibilities. Drawing out the important information is sometimes difficult. The interviewer must talk softly and slowly. Native Americans Native Americans -- particularly on tribal lands -- experience some of the highest rates of chronic disease and disability in the U.S. compared to the general population. Yet they receive a proportionately smaller share of resources. More than one fourth of Native Americans between the ages of 15 and 64 have a disability. (The Rural Exchange, April 1997.) Native American Culturally Related Characteristics (Native Indians Information Sheet, '97 ATTAC Winter Conference.) Steeped in the culture of the tribe, usually tribe and extended family come first before self. Believe in healers, natural medicine and mystical power. Concept of sharing, such as Mother Earth belongs to all people. Honor your elders, wisdom and traditional ways. Be carefree, enjoy life and oriented to the earth. Religion is the universe and learning through legends. A low-key mannerism and flexible. Time perception -- view time as a natural phenomenon Intuitiveness. Cultural bound values, concepts, communication style and beliefs. Harmony and cooperative behavior are valued and encouraged. Ethnic pride, patience and acceptance of suffering and pain. Work for a purpose and don't criticize other people. Did You Know That... In the Latin culture there's an acculturation process which involves gaining understanding of the host culture and then making choices about which parts to accept or reject. In the Japanese culture the power of shame, the tendency to keep personal problems within the family and the value placed on stoic resignation contribute to Japanese person's reluctance to come for psychiatric treatment. The Vietnamese language does not have words for psychiatry, schizophrenia and depression. These linguistic gaps have been problematic in the assessment of Vietnamese patients by Western Clinicians and in the application of Western based diagnostic methods. In some Native American languages there is no word for advocacy. P&A News; ATTAC of NAPAS 900 2nd St., NE #211 Washington, D.C. 20002 (202) 408-9514 voice; (202) 408-9521 TTY (202) 408-9520 Fax E-mail: NAPAS@VIPMAIL.EARTHLINK.NET Webpage: http://www.protectionandadvocacy.com Managing Editor: Vicki Smith Editor: Beth Weintraub Falk NOTES BELIEF SYSTEMS African-American Belief System\2\: 1. Spirituality- belief in a Supreme Being; emphasis on spiritual over material or integration of the two in everyday life; 2. Expressive/Orality - receive and transmit information orally; rhythmatic communication; 3. Harmony - emphasis on integrating parts of one's life into a whole; interdependence of person with environment; 4. Time - time viewed as beginning when everyone arrives rather than as measured by the clock; time is circular and fluid, not discrete and unconnected; 5. Rhythmic Movement - observed in gross motor movements; 6. Stylistic Expressiveness - in all manners of expressing self, person has unique style, flair, spontaneity, and improvisation; and 7. Affective Sensitive to Emotional Cues - synthesizing words and objects integration of feelings with beliefs; integration of the verbal and nonverbal; emotional expressiveness. Latin-American Belief Systems\3\: 1. Familialism - emphasis on the family as the main source of support, including the extended family (i.e., care for the elderly and all family members); 2. Communalism - accepting the Native American cultures' view that the person is an open system; interaction with nature and with the community; more emphasis on cooperation than on competition; 3. Allocentrism - relational emphasis; more emphasis on other rather than on self; Latino culture places emphasis on the people and inter-personal relationships than on tasks; 4. Diversity - openness to diversity, acceptance of different cultures; 5. Spirituality - emphasis on the spiritual over the material; belief in a Supreme Being; 6. Expressive Communication/Orality - strong oral tradition to receive and transmit information. 7. Time - time viewed as beginning when everyone arrives rather than measured by the clock. (Excerpted from "Multicultural 101: An Advocates Guide to Awareness, Responsiveness, and Competence in Casework," by L. Elaine S. Mbionwu.) 1. Excerpt from, "Multicultural 101: An Advocates Guide to Awareness, Responsiveness, and Competence in Casework," by L. Elaine Sutton Mbionwu; Mental Health Advocate, Georgia Advocacy Office, 1997. Full copy available from ATTAC. 2. African-American World View (Akbar, 1979; Myers, 1988; Phillips, 1990; Randolph & Banks, 1993.). 3. Zea, Quezada, & Belgrave, (1994) ---------- LITERATURE REVIEW OF MULTICULTURAL OUTREACH MATERIALS LIBRARY AVAILABLE FROM THE ADVOCACY TRAINING AND TECHNICAL ASSISTANCE CENTER Prepared July 1997 I. Outreach to Arab Americans: Communicating and Interviewing Strategies for Arab Americans with Disabilities, January 17, 1997, approx. pgs. 30, National MultiCultural Institute. This text was compiled specifically for training to P&As on outreach to Arab American communities. The document explains terms and concepts relating to the Arab family and gender systems and offers suggestions for dismantling cultural barriers that restrict access to mental health services. II. Outreach to Asian Americans: Asian Americans, by Sam Chan, Ph.D., 1993, pgs. 9, Multi-Ethnic Competency Institute. This article discusses cultural considerations for successful outreach to Asian Americans, including demographics, history, education and family. The article also discusses attitudes towards Asian American individuals with disabilities and the affect of these attitudes on the receipt of medical services. Asian American Children in Special Education, by Ji-Mei Chang, Ph.D., pgs. 8, 1994, Division of Special Education and Rehabilitative Services, San Jose State University. This report discusses the following interrelated areas of concern: 1) The myth of model minority students; 2) Fragmented instructional services and 3) The movement toward full inclusion. The article provides case studies of Chinese American students with learning disabilities and limited English proficiency. The text further illustrates possible means of collaboration among teachers, parents, specialists and the community in order to help schools meet the needs of Asian American students with disabilities. The Employment of Asian\Pacific Minority Persons with Disabilities, by Alan H. Woo, 1994, pgs., 7, Asian Rehabilitation Services. This report discusses barriers to employment of Asian\Pacific minority persons with disabilities including: 1) Cultural, family and language difficulties; 2) Lack of culturally relevant assessment tools; 3) Inappropriate rehabilitation techniques; 4) Differences in cultural values, beliefs and practices and 5) Lack of culturally sensitive, linguistically appropriate staff training. The article provides a thirteen point plan to help overcome cultural and language barriers to employment for Asian\Pacific minorities with disabilities. Excerpt from: The State of Asian Pacific America: A Public Policy Report, February 1996, pgs. 11, Leadership Education for Asian Pacifics, and the UCLA Asian American Studies Center. This executive summary of the book's contents provides a projection toward the year 2020 regarding immigration, population, labor, civil rights, women, health, education, and culture. III. Outreach to Latino and Hispanic Americans: Cultural Competence Guidelines in Managed Care: Mental Health Services for Latino Populations, December 1996, pgs. 39, National Latino Behavioral Health Workgroup, published by the Western Interstate Commission for Higher Education. This report examines how the transition into managed care creates unique concerns for the Latino populations in the United States. The report sets forth a set of guiding principles and guidelines concerning cultural competency including planning, governance, design, monitoring, staff training, assessment, and case management. Hispanics in The United States: An Insight into Group Characteristics, by Santiago Rodriquez, July 1995, pgs. 11, Department of Health and Human Services. This article provides information and statistics about Hispanic Americans in the United States. Issues discussed include nomenclature, group stereotypes and the origins of major subgroups. Outreach and Advocacy for Black and Hispanic People with Mental Disabilities, 1990, approx. Pgs. 300, National Health Law Program. This source book is designed to help staff, advisors and members of protection and advocacy governing boards become aware of barriers to services and rights violations faced by minority individuals with mental health disabilities. The book also provides guidelines for reaching out to minority consumers, identifying consumer advocacy needs, and developing strategies to protect rights. Patient's Rights and Advocacy: for Hispanics? 1981, pgs. 66, Intercultural Development Research Association. This monograph outlines key issues in the area of patient's rights and advocacy as they relate to Hispanic mental health clients. The report delineates several assumptions which are dominant in mental health service delivery systems. These assumptions may limit the development of patient advocacy rights and the overall advocacy movement for Hispanics. IV. Outreach to Native Americans: American Indian Developmental Disabilities Research Project, 1993, pgs. 15, Three Feathers Associates. This is an executive summary of findings from interviews with key federal officials and a national survey of professionals who provide services to Native American populations. This summary also includes recommendations for policy makers and service providers at the state, national and tribal levels regarding the delivery of effective services to Native American populations. American Indian Rehabilitation Programs: Unmet Needs, Twenty-First Institute on Rehabilitation Issues, October 1995, pgs. 153, Arkansas Research and Training Center in Vocational Rehabilitation, Hot Springs Rehabilitation Center, Arkansas Rehabilitation Services, University of Arkansas, Fayetteville. This monograph summarizes the findings of a discussion group comprised of 11 professionals in the field of Native American rehabilitation. The monograph examines various rehabilitation models currently being used to serve Native Americans and Native Alaskans with disabilities and suggests alternative rehabilitation models that are more effective for providing cross-cultural rehabilitation services. Indian Adolescent Mental Health, January 1990, pgs. 82, U.S. Office of Technology Assessment, OTA-H-446 U.S. GPO. This report focuses on current knowledge about the mental health needs of American Indian and Alaska Native adolescents and the service systems that have evolved to treat them. The report identifies various treatment options and successful interventions. Indian People in Indian Lands: Profiles of American Indian and Alaska Native Populations in Various Settings, April 1986, pgs. 52, U.S. Department of Health and Human Services. This analysis of data from the 1980 census provides a snapshot view of the socioeconomic characteristics of American Indians and Alaska Natives, including the diversity of Native Americans living on or near reservations and Alaska Native villages in 1980. Native American Disability Directory of Individuals and Agencies, 1993, pgs. 170, Three Feathers Associates. This directory serves the following functions: 1) Links individuals with disabilities with providers of services; 2) Facilitates communication among and between individuals with disabilities and their families; 3) Identifies advocates and self advocates at tribal, state and national levels and 4) Facilitates communication between and among practitioners. Outreach Services for American Indians, by Priscilla R. Sanderson, 1994, pgs. 4, American Indian Rehabilitation Research and Training center, Northern Arizona University. This paper discusses the importance of designing outreach services which involve learning about the history, culture, customs and tribal politics of Native Americans. IV. Outreach to More Than One Minority Population: Beyond Awareness: Action Strategies for Promoting Cultural Diversity in the Developmental Disabilities network, 1991, pgs. 16, The Multicultural Task Force in the Field of Developmental Disabilities, sponsored by the Administration on Developmental Disabilities. This report is a blueprint for the promotion of cultural diversity among the numerous agencies supported by the Administration on Developmental Disabilities (ADD). The blueprint is comprised of: 1) A statement of shared cultural competency principles within the ADD funded network; 2) A philosophy for promoting action; 3) A plan for stimulating action; 4) A dissemination plan for identifying and distributing tools for action and 5) A forum for promoting action within the ADD network of funded agencies. Culturally Competent Service Systems Outcomes Assessment Tools: Guidelines for Upgrading Quality Assurance, Linda James Myers, Ph.D., pgs. 5, Office of Consumer Services, Ohio Department of Mental Health. This article is intended to facilitate the development of a culturally competent health care service delivery. The article sets forth cultural competence assessment tools in three performance categories including administrative, clinical, and financial. Cultural Diversity and Rehabilitation Training Guide, for I-NABIR Fall Training Conference, October 31, 1994, pgs. 45, Rehabilitation Cultural Diversity Initiative and Rehabilitation Continuing Education Program, San Diego State University. This training manual was developed as part of a national program which provides support to state rehabilitation programs and the client assistance programs in order to increase participation of culturally diverse populations at all levels within the public rehabilitation systems. The manual defines diversity and cultural competence and provides demographics of underutilized populations. Meeting the Unique Needs of Minorities with Disabilities: A Report to the President and the Congress, April 26, 1993, pgs. 51, National Council on Disability. This report provides an abstract of the findings presented at a National Council on Disability conference and an ADA Watch hearing on minorities with disabilities. The report found that there has not been sufficient outreach efforts to ensure the inclusion of minority persons with disabilities in all aspects of society. The report recommends that federal, state and local disability programs should develop outreach efforts to ensure full participation of minority persons with disabilities. Source book for Multicultural Access to Federal Programs, July 1993, pgs. 57, Howard University Research and Training Center, Center for Disability and Socioeconomic Policy Studies School of Education. This source book provides information about multicultural access to federal programs, grants and career enhancement opportunities for individuals, institutions and agencies. In addition, the text includes a list of employees who may be contacted regarding the needs of persons with disabilities and their families. Multi-Cultural Groups with Disabilities: An Annotated Bibliography, 1990, pgs. 110, Waisman Center University Affiliated Program, University of Wisconsin-Madison. This text contains books, articles and reports for use by professionals preparing to work with members of minority groups who have disabilities. The bibliography covers how cultural perspectives, understandings, training and access affect the provision of health and educational services to African Americans, Native Americans, Hispanic Americans, Asian Americans and multi-racial populations. Towards A Culturally Competent System of Care: A Monograph on Effective Services for Minority Children who are Severely Emotionally Disturbed, March, 1989, pgs. 75, CASSP Technical Assistance Center Georgetown University Child Development Center. The monograph serves the following functions: 1) Provides a definition for cultural competence; 2) Sets forth a cultural competence continuum; 3) Outlines elements that contribute to an organization's ability to become culturally competent; 4) Identifies a set of underlying values and principles of a culturally competent system of care and 5) Provides some practical ideas for improving service delivery for children of color who have severe emotional disturbances. ---------- End of Document