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LGBTQ+ communities comprise 16 million individuals in the United States, yet this population is often rendered invisible within disaster policies. Bias in federal disaster response programmes, a lack of recognition of LGBTQ+ families, and the prevalence of faith‐based organisations in disaster relief services together heighten the risks that LGBTQ+ individuals face. This paper describes the ways in which this reality combines with the contextual vulnerability of LGBTQ+ communities, whereby existing inequalities and marginalisation are exacerbated during disasters and in their aftermath. As a result, the immediate trauma of a disaster, such as physical injury or the loss of loved ones or possessions, is compounded in multiple ways for LGBTQ+ individuals, making them less likely to benefit from disaster relief services. To address these inequalities, the paper concludes with a set of policy recommendations to inform prevention, mitigation, and recovery planning, as well as to reduce the impacts of disasters on LGBTQ+ individuals. [ABSTRACT FROM AUTHOR]

Culture can broadly be defined as "the values, norms, and assumptions that guide human action" (Wilson 2008, 14). In contrast with the broader civilian society, the experiences and environments within the military community create a unique cultural subset. The United States armed forces are unified by their primary mission to provide external defense, security, and protection, and each branch (Army, Navy, Marine Corp, Air Force, Coast Guard and National Guard) shares a unique core set of values and norms. Because this culture is so complex and unique, it can sometimes be a challenge for many civilian professionals to work with this community, so having a strong competency in understanding military culture, as well as knowledge of specific conflicts and wars, one is not only able to begin to understand the lives and personalities of our soldiers but also able to recognize that this culture aids in survival. This paper will demonstrate and discuss the importance of competency in military culture when practicing music therapy or other interdisciplinary approaches within the process of group therapy with veterans. Other topics covered will include: issues of social transmission as it relates to transitioning into civilian society; the importance of being a witness to veterans' stories; and facilitators' ethical responsibilities when working with this population. [ABSTRACT FROM AUTHOR]

Introduction: Healthcare organisations serve clients from diverse Indigenous and other ethnic and racial groups on a daily basis, and require appropriate client-centred systems and services for provision of optimal healthcare. Despite advocacy for systems-level approaches to cultural competence, the primary focus in the literature remains on competency strategies aimed at health promotion initiatives, workforce development and student education. This paper aims to bridge the gap in available evidence about systems approaches to cultural competence by systematically mapping key concepts, types of evidence, and gaps in research. Methods: A literature search was completed as part of a larger systematic search of evaluations and measures of cultural competence interventions in health care in Canada, the United States, Australia and New Zealand. Seventeen peer-reviewed databases, 13 websites and clearinghouses, and 11 literature reviews were searched from 2002 to 2015. Overall, 109 studies were found, with 15 evaluating systems-level interventions or describing measurements. Thematic analysis was used to identify key implementation principles, intervention strategies and outcomes reported. Results: Twelve intervention and three measurement studies met our inclusion criteria. Key principles for implementing systems approaches were: user engagement, organisational readiness, and delivery across multiple sites. Two key types of intervention strategies to embed cultural competence within health systems were: audit and quality improvement approaches and service-level policies or strategies. Outcomes were found for organisational systems, the client/practitioner encounter, health, and at national policy level. Discussion and implications: We could not determine the overall effectiveness of systems-level interventions to reform health systems because interventions were context-specific, there were too few comparative studies and studies did not use the same outcome measures. However, examined together, the intervention and measurement principles, strategies and outcomes provide a preliminary framework for implementation and evaluation of systems-level interventions to improve cultural competence. Identified gaps in the literature included a need for cost and effectiveness studies of systems approaches and explication of the effects of cultural competence on client experience. Further research is needed to explore the extent to which cultural competence improves health outcomes and reduces ethnic and racially-based healthcare disparities. [ABSTRACT FROM AUTHOR]

A study was conducted with the aim of identifying themes about the lived experiences of Black men in relation to law enforcement. An all-black male focus group was engaged in discussions on the topic 'Do Black Lives Matter' at an annual conference on counseling racial and ethnic minorities. The group participants consisted of counselors, counselor educators, undergraduate students, graduate students, and a law enforcement representative. Data from the discussion were qualitatively analyzed to identify themes and to give voice to Black male experiences. This paper presents findings regarding these themes (anger, fear, training/re-education) based on the group discussion and group process observations as well as indications on how the findings can be used toward action and change. [ABSTRACT FROM AUTHOR]

In this paper we present the current state of cultural diversity education for undergraduate medical students in three English-speaking countries: the United Kingdom (U.K.), United States (U.S.) and Canada. We review key documents that have shaped cultural diversity education in each country and compare and contrast current issues. It is beyond the scope of this paper to discuss the varied terminology that is immediately evident. Suffice it to say that there are many terms (e.g. cultural awareness, competence, sensitivity, sensibility, diversity and critical cultural diversity) used in different contexts with different meanings. The major issues that all three countries face include a lack of conceptual clarity, and fragmented and variable programs to teach cultural diversity. Faculty and staff support and development, and ambivalence from both staff and students continue to be a challenge. We suggest that greater international collaboration may help provide some solutions. [ABSTRACT FROM AUTHOR]

Recent years have witnessed an increasing attention to the vast and alarming health disparities in the United States. This paper explores provider factors in health disparities, considering the role of medical education in training health care providers to practice culturally responsive health care toward a diminution of health inequalities. The paper begins with a description of culturally responsive care along with an overview of the key elements of a comprehensive curriculum for health care providers in this arena. Next, the paper explores the key contributions from the field of psychology to collaborative instruction of health care providers in the areas of attitudes/awareness, knowledge and skills components of culturally responsive care. Finally, the paper concludes with a description of collaborative teaching from a family medicine residency program where a 33-h ‘cultural medicine curriculum within the curriculum’ is delivered over the course of 3 years. [ABSTRACT FROM AUTHOR]

There has been a growing interest among recreational services in becoming culturally competent in order to work with diverse communities. Many professionals have knowledge regarding cultural sensitivity or awareness of the importance of cultural differences when providing services. And even more have participated in culture-specific training to acquire skills needed to provide these services. However, there is now a need to view cultural competency as a system or quality of care issue where each recreation service provider is held accountable to providing responsive and culturally competent services. Given the demographic changes regarding people of color within the United States, much interest has centered on providing culturally appropriate approaches to recreation services. Why? Because we are continually reminded that the traditional "minority" groups will be the "majority" in the very near future. This is especially true when attempting to provide services to children and youth of color, where traditional programs and services developed by and for the European American culture have often failed to engage youth of color. Issues around misinterpretations, lack of knowledge, and racism exist for those with cultures other than European American and can lead many youth of color to appear to be disinterested and/or rebellious regarding recreational programs and services when those determinations may be inaccurate. Recent research also illustrates that youth of color benefit from strong culture-specific programs and from staff who are caring and sensitive regarding racial and cultural differences (Belgrave, Chase-Vaughn, Gray, Addison and Cherry, 2005). With the rising costs of delivering services and the increased emphasis on providing quality services, professional associations, local government parks and recreation departments, non-profit agencies and program funders are increasingly seeking definitions, assessments and guidelines for addressing cultural competency. Guidelines are important because they provide professionals a systematic source of recommended behaviors to follow. This paper is a starting point for the field by suggesting specific guidelines for becoming culturally competent when working with youth of color. As advocated in this paper, changes must take place not only in the provision of direct services but also in professional-community relations and, ultimately in the way recreational professionals and others are prepared to work with youth of color. The guidelines provided here emphasize a sociocultural framework that considers values, interactional styles, and cultural expectations as well as the influence of the family, cultural, social and environmental contextual factors. [ABSTRACT FROM AUTHOR]

A number of conceptual frameworks have emerged with the goal of helping clinicians understand and navigate the intersections of the health system and broader political, economic, and cultural processes when they care for patients. In this study, we analyze the impact that one emerging framework, "structural competency," had on medical students' and physicians' understanding of societal problems affecting patient health and the practices of health systems. In this sub-analysis of a longitudinal qualitative study conducted between August and December 2020, we analyzed 19 semi-structured interviews with 7 first-year medical students, 7 upper-level medical students, and 5 physician course facilitators who participated in a course called Introduction to Medicine and Society at an medical school in the United States affiliated with a large urban academic medical center. This paper focuses on three main findings: how medical students and faculty describe "structures" and their effects on patients and patient care; how they use or imagine using structural competency to improve patient-physician communication and work interprofessionally to address social needs; and the emotional and personal reactions that confronting societal challenges provokes. We conclude that structural competency enhances existing efforts to improve patient-physician communication and to address patients' social needs. However, we highlight how structural competency efforts might fall short of their goal to shift physicians' perspectives "upstream" to the determinants of health due to both critical ambiguities in the concept and inattention to the emotional and personal impacts of addressing societal problems in the clinic. These findings have practical implications for how clinicians are trained to act on societal issues from within the health system and conceptual implications for refining how existing frameworks and curricula conceive of the intersection between healthcare and broader processes. • Ambiguity of 'structure' and 'structural competency' hinders applicability. • Emphasis on 'structure' may unintentionally essentialize marginalized patients. • Trainees' affective responses are key to addressing societal factors in the clinic. • Humility and self-reflection helped trainees better address 'structure'. [ABSTRACT FROM AUTHOR]

Disparities in health exist among ethnic/racial groups, especially among members with limited English proficiency (LEP). The session described in this paper aimed to teach medical students the skills needed to communicate with patients with LEP. Description - We created a required session titled ''Cross-Cultural Communication-Using an Interpreter'' for third-year medical students with learning objectives and teaching strategies. The session plans evolved over three years. Program Evaluation - Students' perceived efficacy using retrospective pre/post test analysis (n=110, 86% response rate) administered 7 weeks post-session revealed that 77.3% of students felt ''more prepared to communicate with a patient with LEP'', 77.3% to ''give proper instructions to an untrained interpreter'' and 76.4% to ''access a hospital language line''. Conclusion - Our curricular intervention was effective in increasing students' perceived efficacy in communicating with a patient with LEP, using untrained interpreters and accessing a hospital language line. Skills practice and discussion of using interpreters should be a part of medical education. [ABSTRACT FROM AUTHOR]

This paper describes the collaborative endeavors between researchers and the Hmong community to develop and test a quality of hypertension care survey instrument. In-depth interviews with community leaders and hypertensive patients enhanced the understanding of quality of care from Hmong socio-cultural perspectives. Knowledge gained from the Hmong community was integrated into the research process. The collaborative process led to generating a culturally sensitive survey instrument, overcoming cultural barriers for recruitment of survey participants, and facilitating community involvement in all aspects of research implementation. Applying community-sensitive research methods ensured the success of the project. [ABSTRACT FROM AUTHOR]

The lack of racial and ethnic match as a barrier to care in mental health treatment services has received considerable attention. In systems of care, which provide public mental health services to African American adolescents, the provider base is largely non-African American. This difference presents a challenge for African American adolescents and their parents who want a provider who is sensitive to the issues, which define their lives. Racial disparities in the utilization of mental health treatment services are well documented; and many providers want to development mental health treatment interventions, which increase access and utilization. However, the findings associated with increasing access and utilization are generally predicated on the structural barriers to care. Very little attention has been given to the non-structural barriers for access to and utilization of mental health treatment services. The purpose of this paper is to increase practitioners’ knowledge of the interpersonal barriers to treatment, which can result from the socio-cultural environment of many African American adolescents. Enhancing the provider knowledge base is viewed as one strategy to closing the racial disparity gap in access to and utilization of adolescent mental health services for African Americans. [ABSTRACT FROM AUTHOR]