Horizon Treatment Services

Ep 04 - CLAS Standards and Equitable Patient Care

• Horizon Treatment Services • Season 1 • Episode 4

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How can we transform healthcare into a more inclusive and equitable system for all? Join us for a thought-provoking conversation with Roland Williams, an experienced addictions therapist and author, who shares his expert insights on cultural diversity in healthcare. Together with our host Jen Slusser-MacTernan, Director of Outreach and Talent Development at Horizon Treatment Services, we promise to unpack the critical role of Culturally and Linguistically Appropriate Services (CLAS) and how they can revolutionize patient outcomes. This episode is a deep dive into the nuances of effective communication tailored to diverse cultural and linguistic needs.

Roland and Jen navigate the intricate landscape of cultural competence and inclusion within healthcare and addiction treatment organizations. They address the complexities of understanding privilege from various perspectives, such as gender, sexual orientation, and socioeconomic status. [Privilege Wheel Activity referenced in this episode is from Heart of Hope by Kay Pranis]. The discussion also highlights the differences between urban and rural cultural contexts and their impact on implementing inclusive practices. By creating safe spaces for staff to share experiences and perspectives on privilege and discrimination, healthcare organizations can foster a more inclusive environment for patients.

Our episode wouldn't be complete without tackling trauma-informed care and its significance in healthcare. We highlight the importance of organizational and clinician buy-in for culturally sensitive approaches, addressing the long-term impacts of childhood trauma on health and behavior. Roland and Jen emphasize the necessity of recognizing implicit biases within healthcare organizations to ensure equitable treatment for all patients. With practical steps for sustaining cultural competence, including regular client feedback and the role of CLAS Champions, this episode equips you with the knowledge to contribute to continuous improvement in healthcare. Tune in to transform your understanding of cultural diversity in healthcare and its broader implications.

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Media - Podcasts (horizonservices.org)

Speaker 1

Horizon Treatment Services, inspiring hope and healing since 1976.

Speaker 2

Considering the diversity of the patients at different institutions around the country. They would be getting instructions, medical advice, agreeing to procedures, and in many cases they didn't understand what they were signing off on and they realized that it was critically important to provide the services in a way that were culturally and linguistically appropriate to the patients that were being served.

Speaker 1

Hello and welcome to the Verizon Treatment Services podcast. We will discuss industry and workforce-related topics around substance use disorder, mental health challenges and co-occurring disorders. We will interview industry experts sharing their own views on best practices for improving patient outcomes in our field. My name is Jen. I'm the Director of Outreach and Talent Development at Horizon and your host for this episode. Host for this episode. I'm here with Roland Williams and today we're going to talk about class, culturally and linguistically appropriate services, primarily in healthcare and in behavioral health. Roland, could you introduce yourself, please?

Speaker 2

Of course. Yeah, my name is Roland Williams and I'm an author, an addictions therapist, a teacher, a person in long-term recovery. I've been working in addiction and mental health field since 1986.

Speaker 1

So you've got a lot of experience in this. You also were on the I don't know what you call it the panel.

Speaker 2

Maybe Also we're on the I don't know what you call it the panel maybe that I was part of an advisory board and we had the task of taking the class standards that were originally intended for medicine medical care and adopting those. We discovered there was a need for that in behavioral health as well, and it was part of the team that helped adopt them in California for behavioral health in 2012,. I think it was.

Speaker 1

That's incredible. So we'll get into that a little bit more. I was thinking as we were getting ready to sit down together, roland, I was thinking about a time when I was a teacher in the county jail and I tried to bring in recovery meetings to that place, and that was a challenge to get folks in from the outside to sort of talk to my guys about recovery. I actually taught about recovery, so inspiring them was really important. Well, I came across a CD of one of your talks that you had given at a Narcotics Anonymous conference and I used that as if it were a curriculum and I played your CD and the guys would sit intently listening.

Speaker 1

There's something about the way that you presented your story that really grabbed them and we would talk about it for the rest of the week, what they related to, what they thought about this. And I was thinking, you know it's really hard to reach these different cultures. You know folks on the inside being having their own culture and I think that we are pretty good at being a very diverse community when it comes to the 12 step programs. But how do we do that in health care? Can you tell us a little about the class standards, what they are and and why we needed to adapt them to addiction services.

Speaker 2

It's for the very reason that you you know the fact that you just told that story about the way that I shared that population was able to hear that, and the reason for that is that the way that I speak, my language, my culture, my experience, my background was one that was in a similar language, similar experience, similar backgrounds to the population that you were working with at that time, and so it's so important. I'm sure you've had a lot of people talk to them and I'm sure that you've talked to them and different people are able to reach them, and those are people that really need to be reached. Something as important as health care, considering the diversity of the patients that were being served at different institutions around the country this country being so full of diversity and so many different populations being represented a healthcare facility and they would be getting instructions, they would be getting medical advice, they would be getting certain documents, they would be agreeing to procedures and in many cases, they didn't understand what they were signing off on. They didn't understand what was about to happen and they realized that it was critically important to provide the services in a way that were culturally and linguistically appropriate to the patients that were being served, and so that's how they started in the beginning, because they thought health care is really important.

Speaker 2

These people need to know what they need to understand, and we can't assume that everybody understands the way we deliver the services. They can't read it, they can't hear it, they can't understand it the same way, and so they decided to do that with health care, and then that branched off. They started realizing that there are other situations where people really need to understand what they're agreeing to and be able to tell their story and be understood themselves. And so behavioral health was a natural transition. For that, you know, because mental health and substance abuse treatment we both know that that's life and death stuff, and so that made sense that that would be the next arena to bring the class standards.

Speaker 1

Yeah, that makes a lot of sense. You spoke about the language, so my understanding is, language is only one of the many standards. There's 15 standards. There's a principal standard that sort of covers the purpose of all of them, right, and the principal standard is to provide effective, equitable, understandable and respectful quality care and services that are responsive to diverse cultural, health beliefs and practices, preferred languages, health, literacy and other communication needs, and you just said that yourself really well.

Speaker 1

I want to just point out that it's not just different languages spoken, right, we don't mean I mean we do mean Spanish needs. We need to have Spanish materials, we need to have the ability to speak to somebody in Spanish through translators or through staff. But there's more than that when we talk about folks understanding what we're delivering, right? So, culturally speaking, let's take a look from the client side. What do you know about if a client shows up to an organization that is, in fact, practicing class standards? What are the benefits to different clients? What are the kind of cultural barriers that can stand in the way that class can sort of mediate?

Speaker 2

Well, you know, first of all, like the culture you just mentioned, we have to broaden our concept of culture. Anyway, you know, like you said, it's so much more than just language. And let's just pause on language for a second. When we think about language, it's not just what specific language a person speaks, it's their literacy, it's their how they use their words. Do they use a lot of slang? Is English their first language? How do they feel communicating with people from different cultures, people that are not like them? Both staff and patients served, clients served. How do they feel?

Speaker 2

Because the communication piece is so critical that you know I need to be able. I need, if I'm writing down as a clinician, if I'm writing down something that I hear a client say and the client is from a different culture to me, whatever I write down becomes part of the permanent record. Communication is not just the language that people speak, it's their understanding. Do they use a lot of slang? Do they feel comfortable communicating with people from a different culture?

Speaker 2

And so if I am going into treatment or I'm a therapist in a treatment program and I'm talking to a client from a totally different culture, if I'm talking to a client from a totally different culture, my communication is likely to be clumsy, it's likely to not be effective as effective as it would be if I'm talking to somebody who's much more like me, much more similar. And so we have to first broaden our concept of language and communication in general, because if we're not talking and we have no, we're not understanding what each other is saying, for various reasons, not only what we speak different languages, but we speak differently then the treatment is not going to be that effective. And, by the same token, we need to broaden our concept of got it. We need to broaden our concept of culture, like you said, and go beyond race, creed, religion, lack of religion, socioeconomic status, sexual orientation. We need to look at things like professions, like formerly incarcerated people. That is a culture, like you said.

Speaker 1

Yeah, and it gets really. You know, intersectionality really impacts this too. So, and privilege right, these are things that we have to talk to our staff about and they fall within the parameters of class standards and the efforts of serving folks with equity, beliefs and practices. You know what are those? How does that differ among cultures? Geography, sexual orientation you just named several military service right, socioeconomic status, age, all of these, all of these different groups, have their own culture among them and some of some of our cultures in our communities, maybe racial cultures or maybe, you know, religious cultures. Some of these are adverse to health care, to accessing health care or accessing it from, as you said, a different race.

Speaker 2

Right.

Speaker 1

And so one of the things that we work on really hard at Horizon, I think we do really successfully, as we reflect our community and our staff, and it's for just the reason that you spoke of, Roland. We can all reach different people, and so we need a collection of different experiences serving the community Absolutely. And so the Office of Minority Health OMH at the US Department of Health and Human Services is dedicated to improving the health and racial and ethnic minority populations through the development of health policies and programs. So they're the ones that have promoted and put forth the CLAS standards. And again, CLAS stands for Culturally and Linguistically Appropriate Services. I often have people write to me about CLASS standards and they write it as if it's a college course C-L-A-S-S.

Speaker 1

And there's only one S on this one. Tell me how you got involved in the adjusting of these.

Speaker 2

A big part of my career, and especially my training career as a person who trains clinical staff and treatment programs, has been around cultural issues. And so I've been, I've done, I've written books around cultural considerations, I do a lot of training around culture. So people knew that that was something that I was always very felt very strongly about and one of the things that I really and I when I first saw the class standards, I was very impressed by the work that had already been done. So we've got the benefit of having the work already been done and then we could just adapt that, just tweak it just much like NA took what the work that AA had done and tweaked it and modified it for narcotics, and that's a great example of kind of an adaptation of something already existing for a specific population. But one of the things that I liked about it and the way that the class standards were designed. They had three principles that all of the 15 class standards would come over and the devil was in the details and a lot of these cultural things. They lacked that kind of the 15 class standards would come over and the devil is in the details and a lot of these cultural things. They lacked that kind of thoroughness. So they had one section of the class standards had to do with governance, leadership and the workforce. So these are the providers, starting at the top, like if it doesn't start at the top, it's not going to work. If the directors and the owners and the leaders of the organization don't buy into it, it's not going to work.

Speaker 2

And then the second theory around class was the communication and language assistant. So you see they separated communication and language. So language is one thing, so you should have written stuff in the language that you speak, but you should also. People should also be able to communicate with you in the style in which you communicate. And then, finally, was the follow-up, engagement, continuous improvement and accountability. So a lot of times, as you know, because I know you are also a trainer we might do a training on cultural sensitivity and they would check it off, they would send, some of the staff would come. The leaders often don't come. They would check it off and say we did our annual cultural sensitivity training but there was no accountability. Did you change anything in your organization as a result of that training? The class standards build all that into it and have implementation strategies for each one of the 15 class standards themselves.

Understanding Cultural Sensitivity in Healthcare

Speaker 1

Yeah, and that's really important. And it's important too. Speaking of communication, it's important to understand as an organization or any healthcare entity, that you know, communicating information to somebody does not in itself, you know, coalesce into behavior change, right? So we may train somebody in implicit bias and explain to them the way that we have to self-reflect as care providers to understand what our own biases are, so that we can sort of block them and shield a client from them by choosing an open mind, by, as you said earlier, active listening, right. These kind of things are really important. But a training about implicit bias in and of itself, without follow-up, without role play, without experiential coaching on the ground, these things are not going to find themselves applied throughout the organization unless there's, you know, a full culture of this. And so how do you develop that?

Speaker 2

Well, first you need to kind of get it. Take a look at the organization that you're working with. You know you do it one person, one organization at a time, and so different organizations. Like you said at Horizons, you're in a very diverse community. You have a very diverse staff, you're very you're not in some rural areas, so you've got a lot of exposure and experience. All organizations aren't like that and all organizations don't have the buy-in. And whenever you're talking about any culture thing and you're talking about underserved populations or populations that have been overlooked or are on the receiving end of a lot of prejudice and unfair treatment, everybody doesn't especially. You see that now, in 2024, the last five, you know, several years you've been seeing a lot of people's. What we do when I do work with people around culture the first thing that we look at is what do we bring to the table? And so we look at an organization the same way, not just the individual staff, but as an organization. What do we bring to the table? How receptive are we to making some changes? Do we think this is a big deal? Do we think this is important?

Speaker 2

Because when you benefit from the status quo, it's hard to have compassion for those who don't, and so if you could be in some organizations. They say we don't really need to do all of that. We don't. You know those people. That's a special cause. Why do they need to be hyphenated? Why can't we all just be one? Why are you still sniveling about something? Why don't you pull yourself up by your bootsteps? Why are you always going to be a victim and they don't have any compassion for it? So there's no buy-in. Also, as a matter of fact, there's a lot of resistance. I'm sure you've seen this when we try to train the staff to say, look, we need to be more culturally and linguistically appropriate, that's implying that we weren't appropriate in the first place. That puts people on the defensive and that automatically you often will get some resistance from the team that you're working with.

Speaker 1

Well, it's interesting that you say that we are in the greater Bay Area. As you mentioned, we're in three counties here San Mateo, santa Clara and Alameda. We are just opening now in a rural community in Butte County in Chico. We're opening a sobering center and we're doing a lot of these trainings there and the experience that we get from our team here and our team there. They're different experiences but it's important because, just as we're talking about cultures, there's going to be an urban and a rural culture to consider right, and so we have to have this open-minded wherever we go and however we do this.

Speaker 1

Um, I was thinking too about uh, privilege and about, uh, how it's not as simple as I once thought it was. I did this exercise that I thought was really interesting, where there was like a uh, a privilege wheel and maybe I can put it in the uh, the chat notes for this podcast if anybody's interested. But uh, the privilege wheel had slices of pie in it and it said, for instance, one uh, religious affiliation, uh, gender, sexual orientation, race, um, you know, socioeconomic status, and it had all of these different sort of slices of what one might be in their identity. And the exercise is everybody has to go in there and rate top in the hierarchy, like how does society view you In these areas in terms of what you believe, who you are? So somebody might have, you know, a number one top of privilege in their gender of male and somebody might have a lower number in their sexual orientation if they identify as homosexual.

Speaker 1

Right at how each of us has areas, of privilege and areas where we don't, where we understand a lack of privilege right, but you would think in something like class, you would think in something when we talk about diversity, I think a lot of times people mean just. They think that we mean just different shades of people, right, but every one of us is its own sort of body of diversity, and so there's a need to sort of understand the way that people's most maybe visible identities may impact their walk in this life.

Speaker 1

Absolutely as well as you know how to create an open and a safe space.

Speaker 2

And when you look at just, you just made me think of something. When you look at just like you said, you know some people. When most people go into a room, they don't. They don't think whether the room is wheelchair accessible unless they're in a wheelchair. They don't think I didn't care about Iraq when Iraq first happened and to my son went to Iraq. Most people don't care about mental illness until somebody in their family has a psychotic break. The opioid epidemic wasn't an epidemic until it got to the suburbs. Then it became an epidemic.

Speaker 2

So people tend to not, you know, if it doesn't affect them, if it's not a part of their day-to-day life. And even when you look at sexual orientation, like the male being the dominant and the homosexual being somewhere you know more likely to be discriminated against. And then there's even a continuum of that, because then let's say a transgender person and let's say not even with the transgender person, there's a transgender person that can pass, and then there's one that's obviously transgender. It all is a continuum of discrimination and second-class treatment and oppression. And not only that, the oppressor feels very self-righteous about that Feels like.

Speaker 2

I don't need to get on board with that. Why are you trying to teach me to get on board with being okay with something that I inherently don't think is okay? I might think that's a sin. So they're not only resistant, they're repulsed by the concept that you're trying to bring that to. And in a metropolitan area like the Bay Area that's a lot less politically correct to admit that you have that opinion. But in some of the more rural places around the country that's the dominant opinion.

Speaker 2

So you see things like if people say they can work with different cultures, we can work with Black people. We can work with dual diagnosis people. We can work with people who just got out of the penitentiary. We saw with Project 36, proposition 36, and AB 104, whatever those were, when we released all those formerly incarcerated people into treatment centers, we found out that programs who thought they could work with formerly incarcerated people really couldn't. A certain kind of Black person. We can work with dual diagnosis people. We can work with a certain kind of dual diagnosis person. So the whole idea about this class standard was to put some response that would first shine a light on the fact that what we've been doing may not have been appropriate if the goal is for these people to get equitable care for them, to get their needs met. We've not been meeting the bar. We've been coming up short when it comes to that.

Speaker 1

Just health care in general in the United States.

Speaker 2

Absolutely, and behavioral health for sure. You know, one of the reasons that cultural considerations became such a big deal for me is that when I went through treatment, I noticed that the black and brown people in the program got kicked out of the program at a higher rate. I noticed the disparity between the way people were being treated by their culture. We had Latinos in the program that couldn't speak Spanish. I learned from being involved in the criminal justice system myself the disparity in the criminal justice system that people were being treated differently for sure. Bigger sentences, longer sentences, more people on death row, a lower percentage of the population, higher percentage of incarcerated people All those statistics were very concerning.

Speaker 1

So thank you for that, and that's a really fantastic overview of some of the challenges Right In all of this, and also just the landscape, the reality of the landscape of health care. Now you speak to the human nature. We fear what we don't know and we become interested and potentially proactive when we're in relationship with one of these things that perhaps previously scared us right, hopefully, hopefully, yeah, you would think right, and I've seen that happen. I've seen that happen. I've seen folks have their mind open when something that they had no experience with walks into their lives. Right, husband or somebody who's killed, maybe it's somebody who commits suicide, maybe it's somebody who we find out is schizophrenic in our family. All of these things make the experience, or I mean just the topic, come to life. It starts to breathe in our lives. That alone does not equip people for being able to care for folks experiencing that. So this is complex, roland, because how do we take? Even well-intentioned people can cause harm, absolutely.

Trauma-Informed Care in Healthcare

Speaker 2

I'm sorry, go ahead, go ahead, go ahead. It starts with, like I said, when we do any work in the arena of cultural and communication cultural-related communication for the benefit of providing the service with the intent that the person is going to be able to receive and get what was intended from the service, we have to look at what we bring to the table. And the cool thing about the class again, it starts at the top. Does this organization believe that we need to improve in this area? What about the way I'm delivering service might need some modification. Where am I dropping the ball? Where do I need more education? Where do I need more skills and what are those skills that I need?

Speaker 2

The organization or the clinician has to buy into that from the beginning and, because of the personalities and because of the cultural, systemic personalities and individual personalities, people have different degrees of sensitivity, interest, commitment to even do that work and you're seeing that right now.

Speaker 2

You're seeing it in the political landscape where people are just dug in, people are just look. This is how I feel. You're not changing the way I feel. You are changing what I believe, and I believe it really passionately and with all my heart and we're seeing people not coming together to say, oh, let's talk about this and let me try to see what it's like to live in your shoes and let's see, let me understand what it's like for you. People are actually pushing away from each other and you see that in organizations especially. In my 37-year career I have seen, of all the things that we work to change in an organization, the thing that you get the most pushback from and the less follow through from really is related to culture and culturally related communication, and when you, when you make any kind of accusation that people are not doing a good job in this people, people have some issues with that.

Speaker 1

Yeah, you said a lot right there, lot right there.

Speaker 1

You know, I was thinking about one of the things that sort of that sort of evens the landscape somewhat right Among humans if we were to try to find a common denominator right, a common denominator that exists on a continuum, as you also mentioned.

Speaker 1

Denominator right, a common denominator that exists on a continuum.

Speaker 1

As you also mentioned, there's been a lot of research recently about trauma and about childhood trauma and about its impacts on adult or later health issues and consequences to physical health, but also the likelihood of engaging in high-risk behaviors and high-risk substance use, and so trauma-informed care is one of the things that may not be explicitly mentioned in the class standards but certainly is in there as a necessity, because, while the traumas that we all endure may be different, it's its own lesson, it's its own training to have a dialogue and a conversation and engagement with staff about how trauma isn't always what happens to somebody, it's how the individual that it happens to experiences it, and how does that person or I mean we're all organisms right so how does that individual's you know functioning system shift in their ability to advocate for themselves, care for themselves, protect themselves?

Speaker 1

When we find somebody who comes into our healthcare organizations, in our substance use disorder organizations, mental health triage systems, are we able to recognize that a lot of the resistant behavior or, you know, a lot of times people are standing and having their feelings in front of you more than they are actually a threat right? So where does trauma-informed care, in your opinion, fit into health care and its relationship with class standards?

Speaker 2

Well, I think that that's such a great example because the attention that trauma-informed care, thank God, has gotten in the last decade or so, where people really validated the need that we need to do something different with this population. We're missing the mark with this population. Trauma is a bigger deal than we thought it is. It's prevalent throughout all of the people, many of the people that we work with. How we've been doing it has not been successful and, as a matter of fact, as you said earlier, even with the best of intentions, we actually could hurt somebody. We were out there thinking we were helping people and we were actually re-traumatizing people, and so we need to change the way we do. We need to learn some different techniques. We need to first address the fact that this population has been underserved and it's a big population. We need to address, admit that they've been underserved, they've not been getting what they needed. We need to train up so that we can do, provide quote-unquote, trauma-informed treatment.

Cultural Competence Standards in Healthcare

Speaker 2

That is the spirit of class. That whole concept is why class came about in the beginning, except that you're looking at a broader picture besides just one population, and much like when we had parity, when they did parity for substance abuse and mental health. They realized that people with substance abuse and mental health insurance companies weren't paying at the same rate. They had crazy restrictions for people with substance abuse and mental health 30 days per calendar year, $100,000 lifetime max you know certain number. They allowed the restrictions that they didn't have for people with cancer, they didn't have that for people with diabetes, they didn't have that with people with other medical illnesses, and so they thought that was really unfair. We're not treating these people unfairly, so let's change that. When they implemented the idea about a parity law that we would treat people the same insurance-wise, the pushback was that we'll do that with mental health, but we won't do that with substance abuse. So the mental health parity law got passed quicker. It was several years later that they passed the substance abuse parity law because mental health was a lot more palatable.

Speaker 2

It was a lot easier to get on board with than it was with substance abuse, because a lot of people still believe the stigma around substance abuse. They believe substance abuse was self-inflicted, that it was weak will all that old stuff about substance abuse. So when we came out with the thing about trauma, people could get on board with that. With trauma, yeah, people got some bad things happen to them. They're having a hard time dealing with it. Yeah, that makes sense. That felt safe. You know they didn't necessarily push anybody say, oh, we don't want to support those trauma survivors. But when it comes to people from minority groups, when it comes to people with different sexual orientations, when it comes to people with different socioeconomic statuses, when it comes to people with different socioeconomic statuses, when it comes to people that have been incarcerated for decades, then they don't feel the same kind of we have more judgments.

Speaker 1

We have more judgments about that.

Speaker 2

Yeah, and I think Less desire to get on board.

Speaker 1

Yeah, less desire to get on board, absolutely, absolutely I are to get on board Absolutely Absolutely which, if we can then couch all of those populations within trauma as sort of an umbrella, then maybe we can actually, you know, engage compassionate hearts to move Right. And I think that that's something that we have to understand as an organization. Right is, we have to be aware of our implicit bias. You know the things that we have maybe not experienced in our life and the way that we have created judgments around it. We have to be aware of that because, as a healthcare provider, we don't have the luxury, as a matter of fact, we have a responsibility not to bring our implicit bias to the workplace, because health care is critical.

Speaker 2

And that's where I start. When I go, when an organization brings me in to do a training around culture in any capacity, whether it's the class, the whole class, conversation or just becoming the organization wants to take a look at their cultural competence or sophistication or service delivery. I start with you know where do you see yourself. You know what do you bring to the table, what are your biases, what are your prejudices. And people have to own that. And I believe that people don't get prejudice free. The idea is to recognize what your prejudices are so they don't interfere with the therapeutic process. Own them so you don't blame them on the clients. Own them what your systemic, your organizational biases and prejudices are, what your individual are. And then also even in the staff community.

Speaker 2

I did a training at Horizon. I've done a lot of training for your organization. For once I was actually at Horizon and I think I told you about. I may have told you about this, but I was doing a group demonstration on how to, because your population is so diverse, the clients are diverse, your milieu is diverse, so you might have 40 clients and they might represent all kind of these minority groups that we're talking about, these disenfranchised, underserved populations. That's right. You would have representation at your organization for 10 or 15 of those different groups.

Speaker 2

All in group together, all in community together, all doing therapy together, all going on outings together. And so I was demonstrating how to get the clients to talk about culture. And one of the clients stood up and said I don't know why. He was a young white man, good guy, good kid, you know, he's about 30 years old. And he, he stood up and he said I don't know why we're talking so much about culture, because nobody discriminates against me and I don't discriminate against anybody else and this is not a big part of my life. So I don't know why we spend hours talking about culture.

Speaker 2

And a woman of color stood up and said well, that might be your story. That's definitely not my story, because people have discriminated me for years. My whole life I've been on a receiving end. And then another person, a transgender man, stood up and said and I agree, you might feel that way and he talked about privilege. The transgender man talked about the privilege that this person has that you can go through life and not have to worry about being called names and people looking at you funny and people treating you like a second-class citizen or treating you turning their nose or pointing and all that you can do. That I can't. So, yeah, we do need to talk about that, and so a lot of people.

Speaker 2

As I said earlier, if you benefit from the status quo, it's hard to have compassion for those who don't, and so, if you like, exposure to different populations is a start, but, just as you mentioned, it's not enough. People need the skills, they need the tools. You know, the cool thing about the class standard is they have 15 very specific tools. Standard is they have 15 very specific tools and, with that cover, that fall under those three different categories governance, communication, language, assistance and engagement, continuous improvement and accountability. So it not only gets the buy-in, it talks about what we're going to focus on and it talks about how we're going to track it. Is your organization really? Did you just check the box and said that you, you did this, you heard this? Okay, cool, or are you really doing it?

Speaker 2

that's right work.

Speaker 1

You have to really make it a internal part of your um delivery of care absolutely yeah, and I think that the uh, the conversation that you just described in the circle with the three very diverse individuals who stood up and made their selves known.

Speaker 1

The hope is that we can have conversations like that, that we can actually each have the opportunity to say what my experience of this is and then be open to exploring that, and that is the challenge, right, that is the challenge, exploring that, and that is the challenge, right, that is the challenge.

Speaker 1

It's really interesting when we talk about stigma and we talk about well, we talk about privilege, when we talk about these things based on the way that those three individuals experience life, that creates within them a different sort of perception of healthcare, a different perception of the safe space that the therapeutic relationship attempts to create. So you spoke briefly about the therapeutic relationship, and that's what class is attempting to safeguard, right? If people are going to get help that they need whether it be substance use disorder treatment, whether it be mental health intervention, whether it be, you know, physical health treatment there has to be a safe space, and that safe space, that therapeutic relationship, has to be something that both parties safe space, that therapeutic relationship has to be something that both parties are comfortable in. So how do you see all of this related to the therapeutic relationship and do you feel like the class standards?

Implementing Cultural Competence in Healthcare

Speaker 2

are helping that. Well, I mean when they are actually implemented. You know and I got to be honest with you, jen, I don't. I see a whole lot of programs who you know. This was this rolled out what 10, 12 years ago? And in the beginning there was a lot of interest in it because it was the new thing, the new kid on the block, you know, cultural competence. But a lot of people didn't want, a lot of organizations didn't want to do the work that they needed to do the follow-through. There were no checks and balances, there was no accountability. There was a lot of personnel changes and so people who may have been a a really proponent of it in the beginning and fought the hard battle for it to go through, they got replaced and the new people didn't see it as such a big deal and so I don't see a lot of you know, real strong implementation of the class standards.

Speaker 2

I think people feel like, well, you know, we're pretty good in this area. We got this. We work with a lot of different people, we know how to work with people, but what you just talked about with the therapeutic relationship, the more diverse the population you're working with and again, we can use the ones that we've just been talking about? Do they feel safe? Do they feel like this person who's providing the treatment is the person that I will actually talk to? Do I trust this person? Is this the person do I think can relate to what I'm talking about? Does this person will they understand my healing practices? This is the kind of person I'll go to for help when I need some help. Who do I go to when I need some help? You know? Will they understand me when I try to tell my story? What's going on? You know what if my, what if my I have a husband? What if I'm a man and I have a husband and everybody's talking about their wives? That's right. I talk about my husband in this group, right, without being shamed, without being people looking at me funny, that's right. I've been spent 20, 30 years in the penitentiary If I've grew, if I'm that kind of person.

Speaker 2

I don't trust authority. Yeah, I have a certain way that I deal with people in authority, right, actually. So now you're an authority. You are an authority figure, right? I come from a culture where the doctor or the provider is 10 steps more important than I am. So, whatever they say, go so they're not challenged that the person who's given me this medical advice or clinical advice, and so there's so many components to it and you have to do it on a case by case basis and you have to ask that question that you just said is this a healthy therapeutic relationship? And what I suggest to people will start with. We hear everybody say, focus on the similarities rather than the differences. Let's talk about the differences though. Yeah, talk about me. I'm damn near 70 years old. You may be 38. I'm black, you're white.

Speaker 1

Bless your heart. No, I'm not, but we'll stay with that. Go ahead.

Speaker 2

Let's say we're having a conversation. I knew I liked you. Let's say you're having a conversation. I knew I liked you. Let's say you're having a conversation with a client. Sure, there's obvious differences. Yeah, whatever the differences may be.

Speaker 1

Right.

Speaker 2

Talk about that, yeah, to put it on the table and say, look, my goal is I'm on your team and I want to help you.

Speaker 2

That's right I recognize that we have a lot of differences. How might those differences interfere with our ability to work together? That's right. That's the conversation to have, a conversation to have, and then once the client. And then we got to hear from the client because rarely history was written by the victim. So we, you know, we get to tell the story about how that session went, what was going on. It'd be interesting to give a client the pen and say what did you think that? How did that session go for you?

Speaker 1

See, you bring up some great things. You bring up some great things. So, as you know, before we wrap up, I want to say a few things. One is you're absolutely right that a lot of places will attempt to implement and, for reasons of organizational structure and you know, turnover and all of these different things class is something that needs to be fully embraced and needs to become a culture, and as people switch out, it can be very challenging to maintain that right. But the best that we can do, I think, is you even said this in the beginning is we have to, as an organization, ask ourselves do we think that we can do better in some of these areas? Are we have to, as an organization, ask ourselves do we think that we can do better in some of these areas? Are we open to attempting to do better in some of these areas? And I will tell you that we at Horizon, we know that we have room to grow. Right, I think that we do very well, but we have a lot of room to grow and those pain point areas show up.

Speaker 1

We have kiosks for our customers, for our clients to give their anonymous feedback of their experience within the organization, and we've gotten some really great things to talk to our team about. As a result of that, we have our class champions. We call them the representative at each program that meets with me quarterly and in person and then online. Between that, every month they're supposed to do a 15-minute class topic review brief conversation and provide some materials about that with their teams and then that is sort of the topic that they're supposed to engage about and look for gaps within their services about that thing. I'll be honest, that's not happening regularly at every program for turnover reasons and for just busyness reasons.

Speaker 1

But you're right, roland, this has to not be something that was the new kid, that was exciting and then fades, because this needs to be at the center of healthcare and at the center of the work that we do for the therapeutic relationship to thrive. And also I'm sorry, I was going to say also the client gets to have bias, the professional doesn't get to have bias And's. That's just the thing. And well, that's not fair. That's what you said earlier, was it? We all have bias, but the professional needs to hold it and and stay open and be a professional in terms of making space. The client is going to come with their stuff, particularly in substance use and mental health. Uh care, right, they're going to come with that stuff and the care providers have to be prepared to deal with that.

Speaker 2

You should assume that everybody has bias and you should especially assume that your client has bias for sure. Your job is to take your bias and do your work on your bias so that it doesn't interfere with your therapeutic relationship with the client.

Speaker 2

And if you get to a point where you feel like I just can't get with this. This guy is just the kind of person because of whatever his race, his sexual orientation, his socioeconomic status, whatever the fact that he did this and he's been in prison, all that I just can't. I don't have the compassion for this guy. Then you need to own that and get out of the way so that that guy can get what he needs in the program. And get out of the way so that that guy can get what he needs in the program. And you know Horizon has done more than you know. When I went to did some stuff at Horizon, we actually did a survey. We surveyed. I had like 200 responses from your clients at Horizon. We wanted to get a sense of what did they think about? How well Horizon was doing with cultural sensitivity, as well as the staff. I surveyed the staff and the clients. We had over 200 surveys.

Speaker 2

I still have them somewhere and it was a wonderful discussion. We had like a great discussion and staff even felt this is also because I like that again in the standards it talks about the whole organization governance, leadership and workforce. So we had staff members not just in Horizon at all these programs that are trying to implement that. You look at the workforce there's bias, prejudice, dissension, judgment, stigma amongst the staff. They're not on the same page. Yeah, you know. And so the goal ideally in a perfect world, you world, everybody would equally see that this is important Equally. See that if we want to and, like you said, we have a responsibility If you're working with this population substance abuse and mental health people are dying.

Speaker 2

We're not making hamburgers, we're not doing this, we're in the business of our lives and if we do it wrong, if we drop the ball, this person could die. This may be the last time they ever get to come to treatment. If they relapse, they may not make it back, so they may not get another chance. So we have a responsibility, if we do this work, to be as skilled as possible. We don't want to be the reason that somebody doesn't get what they came for as an individual and as an organization, your organization has done twice as much, three times as much, four times as much as most, most of them. This isn't even a conversation. The way that they deal with this is they have a mandatory training on cultural sensitivity. Boom, check the box off. We did that and they go about business as usual. And even in those trainings, rarely, jan, does the CEO or the director or the big boss, the decision makers, the shot callers, rarely do they even come to it. That's right.

Speaker 1

Well, I got to tell you, Roland, I can't think of a better place to end than there. You did a beautiful job of summarizing everything that we've been talking about and its value to the work that we do. I want to thank you again for your time today and for all the work that you're doing in the community in the world. I know that you travel all around the world and provide learning experiences around relapse prevention and cultural sensitivity and all of these topics that you've masterfully taught to folks in our workforce, and I want to thank you.

Speaker 2

Thank you, and thank you for the work that you do and thank you for being one of the authentic ones in this business.

Continuous Improvement in Healthcare

Speaker 1

That's right, thank you. Thank you for saying that and you know, like I said, we're all still growing. The organization, the individuals. We're all aiming good, better, best. Our CEO, Jamie Campos, likes to say we are a continuous improvement and we work towards good, better, best, and we like to say that we're good. We like to say we're at better, but best is a moving target, my friend.

Speaker 2

I heard that. Yeah, but thanks so much for having me. It's great seeing you always.

Speaker 1

All right, roland, take care Okay you too. Bye-bye, bye. Please visit our website to learn more and to connect with us on social media. Our website is wwwhorizonservicesorg. Horizon Treatment Services, inspiring hope and healing since 1976.