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|Multicultural Competency in Wellness|
Gain tools and resources to enhance multicultural competency in yourself, your clients and employees, your community, and your workplace when you earn your Multicultural Competency in Wellness Certificate. >>
The Mission of the National Wellness Institute (NWI) Multicultural Competency Committee is to support NWI with increasing inclusiveness by advancing multicultural competency within wellness best practices, and to assist with the development of knowledge, awareness, and skills to deliver equitable and culturally appropriate programs and services for wellness practitioners, organizations, underserved populations, and communities.
The Goals of the Multicultural Competency Committee include:
Wellness is considered to be an active process of becoming aware of and learning to make choices (healthy choices) that lead toward a longer and more successful existence. – NWI definition.
WELLNESS has different meanings for different populations. The first step towards an effective wellness program is understanding what it means to your audience.
The Multicultural Wellness Wheel is designed to support wellness practitioners and related stakeholders in broadening their outlook as it relates to the concepts of wellness and well-being, and to support the recognition of the interlocking systems displayed within the wheel. This concept map addresses applied multicultural competency and the needs and goals of individuals, families, and workplaces. It also provides a guide for the development of well communities and civic infrastructures.
The Multicultural Wellness Wheel focuses on three pillars for optimal and lifelong well-being:
Personal & Family Wellness
MIND – BODY – SPIRIT
Supporting underserved communities and minimizing healthcare disparities via the following approaches:
Upstream: Policies, incentives & regulations
Worksite Diversity Initiatives
Work/life Balance Components
How Can Wellness and Healthcare Practitioners Develop and Apply Multicultural Competency?
By becoming aware of one’s own personal assumptions about human behavior, values, bias, stereotypes, and personal limitations. Practitioners learn who they are as “cultural beings” and how cultural socialization has shaped their worldview and their ability to work effectively with culturally diverse populations.
A culturally skilled practitioner is one who actively attempts to understand the worldview of their culturally different clients without negative judgments, and shows respect and appreciation for human differences.
A culturally skilled practitioner is mindful of actively developing and practicing culturally appropriate intervention strategies and working appropriately within diverse communities.
Serves as a Tool for Sustained Engagement…
The Multicultural Wellness Wheel serves as a tool for sustained engagement and personal reflection, supports dialogue and discussions, and assists practitioners with individual, family, workplace, and community wellness initiatives related to their unique communities of practice.
The wheel fosters the building of healthy relationships across cultural differences within diverse communities of practice.
Measuring Worksite Wellness Programs by Multicultural Competencies Standards
By: Linda Howard
Does Your Worksite Wellness Program Measure Up?
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If your worksite wellness program were to be measured against multicultural competency standards, would it meet, exceed, or fall short of those standards? As you will see, ensuring that your program considers the attributes and demographics that make up culture is mandated by a number of federal laws, renders a greater return on your investment, and serves the public good. When I speak of multicultural competency as it relates to worksite wellness, I am looking at the competency of those who design and implement the program as well as the program’s overall effectiveness in serving people of different cultures. Multicultural competency requires the individuals designing or implementing the program to:
Many people confuse "diversity" with "multicultural competency." They mistakenly use the terms interchangeably. While diversity is a good starting point, diversity does not equal multicultural competency. Nor do you achieve diversity by varying your team considering race alone. Cultural competency encompasses more than race. Culture includes such things as religion, gender, socioeconomic status, geographic location, language, sexual orientation, and education. Having a diverse group of people at the table is an excellent way to learn about other cultures; it is a way to begin to meet the second requirement on the list above (to possess knowledge of different cultural practices and worldviews).
Multicultural competency is a skill that must be learned. The answer as to whether your team has multicultural competency skills will largely turn on the answer to the following question: has your team had multicultural competency training? If the answer is no, then your team is probably lacking some element of multicultural competency.
To determine if your program measures up, I say the proof is in the pudding. It’s not just about your intentions; it’s also about results. Evaluate your program to see its effectiveness across cultural lines and whether it is in compliance with laws designed to eliminate discrimination and promote inclusion in wellness programs.
Why Should Worksite Wellness Programs Focus on Multicultural Competency?
Why should you care if your program measures up by Multicultural Competency standards? Simply put, because the law says you must and because you should!
Why Should Your Worksite Wellness Programs Focus on Multicultural Competency? Because They Should
You should be concerned about the effectiveness of your wellness program across cultures for the good of it – the social good, as a good business practice, and because programs that lack multicultural competency simply "ain’t good."
Smart Business Decision
Racial and ethnic health disparities add another layer to the correlation of employee health and business productivity. Many employers are generally unaware of racial and ethnic health disparities as a business issue.2 It is important to recognize that many chronic diseases related to health disparities, such as hypertension, diabetes, cancer, cardiovascular disease, and obesity, greatly effect productivity and absenteeism. It follows that reducing or better managing of chronic diseases improves productivity and absenteeism. Since ethnic minorities and the poor have higher incidences of chronic diseases, reaching these populations (which is achieved with culturally competent programs and coaches) is critical to improving productivity numbers and reducing absentee numbers.
Lastly, studies have shown that effective wellness programs reduce the cost of insurance. Therefore, not only is there social good in positively impacting people’s wellbeing and reducing the stress on the U.S. healthcare system, there is a good business case for effective wellness programs that speak to a cross section of the population. A multiculturally competent wellness program will only serve to increase productivity while further reducing insurance cost and other expenses related to absenteeism. The business case is simply that it will improve the bottom line.
Standardized Programs Don’t Work
Why Should Your Worksite Wellness Programs Focus on Multicultural Competency? Because They Must
Worksite wellness programs must comply with numerous federal laws requiring that employers recognize disparities as well as genetics and physical and mental limitations when designing programs to avoid discriminatory behavior and impact.
Patient Protection and Affordable Care Act
The Act was passed by Congress and then signed into law by President Obama on March 23, 2010. It is comprised of the Affordable Health Care for America Act, the Patient Protection Act, and the healthcare-related sections of the Health Care and Education Reconciliation Act and the Student Aid and Fiscal Responsibility Act. It also amends several other federal laws, such as the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the Employee Retirement Income Security Act (ERISA) of 1974, and the Health and Public Services Act. Additionally, it reauthorizes The Indian Health Care Improvement Act (ICHIA).
The Act prohibits discrimination in wellness programs that are group health plans. It is very prescriptive as to standards and requirements that must be met to avoid discrimination in these wellness programs.
The Age Discrimination in Employment Act of 1967 (ADEA)
An example of a practice that could cause issues with ADEA is if the wellness program has a mandatory program that requires employees to meet a certain health standard which does not consider the age of the employee.
Americans with Disabilities Act (ADA) and The Rehabilitation Act of 1973
Note: The ADA does not, however, prohibit employers from inquiring about employees' health or doing medical examinations as part of a voluntary employee health program as defined by the ADA. For guidance on designing a wellness program that is ADA compliant, read “Are You Up-to-Date on ADA and Wellness Programs Compliance? - EEOC's Final Rule on Employer Wellness Programs and the Americans with Disabilities Act.”
The Rehabilitation Act of 1973 makes it illegal to discriminate against a qualified person with a disability in federal agencies, in programs that receive federal financial assistance, or in any federal employment, including the employment practices of federal contractors. It also requires that employers covered by the Act make reasonably accommodations for the known physical or mental limitations of an otherwise qualified individual with a disability unless doing so would impose an undue hardship on the operation of the employer's business.
An example of how a program could violate the ADA or the Rehabilitation Act is when an employer has a program that rewards employees for taking so many steps a day or walking a certain number of miles a week. An employee with a disability that limits his or her ability to walk could not be participate and therefore cannot earn an award in the program (the additional compensation). To remain in good standing, the program would need to provide alternative methods for the disabled employees to earn the additional compensation.
Title VII of the Civil Rights Act of 1964 (Title VII)
The Act also requires that employers reasonably accommodate applicants' and employees' sincerely held religious practices, unless doing so would impose an undue hardship on the operation of the employer's business. A violation on religious grounds could arise if an employer requires employees to submit to a health screening to qualify for savings on their premiums and an employee refuses to submit to the screening based on religious beliefs.
The Genetic Information Nondiscrimination Act of 2008 (GINA)
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
A wellness program that is a part of an employer-based health plan could face problems under HIPAA if the wellness program is not "reasonably designed" to promote health or prevent disease, or if the full reward is not available to all similarly situated individuals.
2 Employer Survey on Racial and Ethnic Disparities: Final Results. The National Business Group on Health. July 30, 20083
3 US Census Bureau. (August 14, 2008). “An older and more diverse nation by midcentury.” Retrieved May 13, 2014, from http://www.census.gov/newsroom/releases/archives/population/cb08-123.html)
4 Examples of states that protect employees from being fired for legal off-duty activity include California, Colorado, New York, North Carolina, and North Dakota.5 There are a host of states that specifically protect tobacco use, including Connecticut, the District of Columbia, Illinois, Indiana, Kentucky, Louisiana, Maine, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Virginia, West Virginia, Wisconsin, and Wyoming.
HHS Establishes a New Conscience and Religious Freedom Division and Vows Vigorous and Effective Enforcement
By: Linda Howard
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The Department of Health and Human Services Office for Civil Rights (OCR)1 has enforcement authority over federal conscience protection statutes and certain federal nondiscrimination laws that prohibit discrimination on the basis of religion in the following U.S. Department of Health and Human Services (HHS) programs and entities:
This past January, HHS formed a new Conscience and Religious Freedom Division in the Office for Civil Rights. If your organization or facility receives certain federal funding and you do not have controls in place to ensure that your organization or facility protects your providers’ conscience and religious freedom, or your patients’ or enrollees’ religious freedom, my advice is to “suit up”. In other words, check your policies, start your monitoring, and develop your training to avoid being the subject of the new and enthusiastic enforcement efforts.
The Conscience and Religious Freedom Division’s mission is to restore federal enforcement of U.S. laws that protect the rights of conscience and religious freedom. In its announcement, the HHS explicitly stated that the creation of the new division will allow HHS to have greater focus on conscience and religious freedom issues necessary to more "vigorously and effectively enforce existing laws protecting the rights of conscience and religious freedom." So, expect more enforcement of Conscience and Religious Freedom regulations.
OCR Director Roger Severino stated in the announcement, "[l]aws protecting religious freedom and conscience rights are just empty words on paper if they aren’t enforced. No one should be forced to choose between helping sick people and living by one’s deepest moral or religious convictions, and the new division will help guarantee that victims of unlawful discrimination find justice. For too long, governments big and small have treated conscience claims with hostility instead of protection, but change is coming and it begins here and now."
If you have refused (or want to refuse) to perform, accommodate, or assist with certain health care services on religious or moral grounds and (1) you are working in an organization or facility that receives certain federal funding, or (2) you are an entity that has been discriminated against by a federal government and any state or local government receiving federal financial assistance, there is now an entire new division that will be dedicated to hearing your complaints and enforcing your rights, when those rights have been violated under the conscience protections provisions of federal laws listed below.
If you are (1) an individual who feels you have been discriminated against in the delivery of services by an organization or facility that receives certain federal funding, or (2) an individual or entity that has been discriminated against on the basis of religion, you too have a division that will, according to the OCR, "vigorously and effectively enforce" the protection of your religious freedom under any of the laws listed below.
Federal statutes protect health care providers’ conscience rights and prohibit recipients of certain federal funds from discriminating against health care providers who refuse to participate in services based on moral objections or religious beliefs. Below are the statutes that provide Conscience Protections.
OCR enforces these laws and regulations that protect conscience and prohibit coercion of providers to perform, accommodate, or assist with services that conflict with such providers’ religious or moral beliefs in HHS funded or controlled programs and activities. Examples of services that a provider may refuse to perform on religious or moral grounds are things like abortion and assisted suicide.
Healthcare providers may file a complaint under the Federal Health Care Provider Conscience Protection Statutes if they believe that they have experienced discrimination because they:
OCR also enforces the following laws and regulations that protect the free exercise of religion and prohibit discrimination in in HHS funded or controlled programs and activities.
The Conscience and Religious Freedom Division in the Office for Civil Rights is a division worth watching. Its enforcement activity will not go without challenge. Religion is a very passionate subject and civil rights is serious business. Challenges will likely come if the exercise of those freedoms is viewed as discriminatory by those who are denied a service by a provider because it is against the providers’ religious or moral beliefs.
Personal conflicts may arise when the religious belief being protected defies the sense of right and wrong of individual regulators charged with enforcing the statutes. Question of “sincere” religious beliefs and convictions may be wrongly assessed from the worldview of the adjudicator and not from the cultural prospective of the one invoking the conscience and religious freedom right.
If regulators lack the multicultural competency necessary to navigate the emotions, beliefs and culture of the complainant, they could render outcomes inconsistent with the stated goal of protecting religious and conscience freedoms. Protecting religious and conscience freedoms may support a fundamental and constitutional right, but it is a hard thing to enforce because there is usually immense passion and unwavering conviction on opposing sides. Just look at the case that highlighted a clash between gay rights and claims of religious freedom when a Colorado baker refused to make a wedding cake for a gay couple2. This issue went all the way to the United States Supreme Court. It takes a lot of passion and conviction, among other things, to get to the Supreme Court.
Regardless of where you fall on issues related to conscience and religious freedom, if you are responsible for overseeing your organization’s compliance with the applicable federal laws, it is time to access your risks and update your policies, because the Conscience and Religious Freedom Division in the Office for Civil Rights has officially been launched.
To file a complaint with the OCR based on a violation of civil rights, conscience or religious freedom, or health information privacy, visit HHS.gov.
1OCR is the law enforcement agency within HHS that enforces federal laws protecting civil rights and conscience in health and human services, and the security and privacy of people’s health information.
2Masterpiece Cakeshop, Ltd. v. Colorado Civil Rights Commission.