Culturally Competent Care in Indian Health Service

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Table of Contents

Subgroup
Needs Assessment
Cultural Competence Plan
Reflection
References

The concept of cultural competence is growing in significance in the field of healthcare. This is because healthcare is one of the areas in which caregivers interact with people from culturally diverse backgrounds. Such a situation requires the physicians and nurses to fully understand the needs of the patients. Several healthcare programs have been established in the United States to target people seemingly ignored by national healthcare initiatives.

The Indian Service (IHS) offers several medical services, including ambulatory, emergency, inpatient, public health nursing, dental, and preventative healthcare, among others (Congressional Research Service, 2016). The program targets American Indians, a minority population with highly specific healthcare needs. The aim is to offer these minorities services that are not guaranteed under the national healthcare program. This paper examines the IHS from a cultural competency perspective focusing on specific concepts, for example, the definition of the subgroup, their needs assessment, and cultural competence plan, among others. The paper argues that the IHS is an embodiment of the application of cultural competence in healthcare.

Subgroup

The IHS includes a specific subpopulation that can benefit from cultural community care. This subpopulation is the American Indians or the Native Americans. The American Indians are a particularly sensitive group because of their socio-economic status. Many authors, researchers, and policymakers agree that their growing numbers and the socio-economic challenges they face render them a vulnerable group.

According to Asante-Muhammad and Ramirez (2019), the recent data shows that their population in the United States exceeds 6.97 million compared to half a million in the 1960s. Other observers highlight that the levels of poverty among the American Indians are incredibly high, with the real median household income recorded at $39,719 as of 2016 (Wilson & Mokhiber, 2017). Slower income growth means that the rate of poverty remains unchanged for a long time.

The American Indians have several special needs that the IHS seeks to address. The program’s behavioral health services identify high rates of substance abuse and mental health disorders as more apparent in this population as compared to the general populace (Congressional Research Service, 2016). Special facilities are needed to fully handle such problems, and behavioral health services are specifically designed for this purpose (Congressional Research Service, 2016). The Indians living in designated lands do have adequate access to healthcare or medical insurance. Additionally, those living in urban areas either lack access and means to afford healthcare or are afraid of using the national system due to various stereotypes. These and other barriers are considered to be special needs.

Needs Assessment

Needs assessment for American Indians by the IHS is difficult to establish, considering that the program is founded on the general perceptions that American Indians are a population with inadequate access to healthcare. However, there are aspects of the program that indicate that there have been efforts to address problems specific to American Indians. As mentioned above, the issues of substance abuse and mental disorders are more apparent among the American Indians as compared to the general population (Congressional Research Service, 2016).

Over 170 service units have been established and managed by the IHS, 40% of which are administered by the Indian tribes (Congressional Research Service, 2016). The presence of the IHS facilities in or near reservations in the rural areas, mostly in Alaska and the Western United States, is interpreted as respectful and representative of the community members and their culture.

A community needs assessment has been done, the result of which identifies the special needs. According to Dennis and Momper (2016), the Indians experience high rates of smoking, obesity, and chronic diseases, and being less likely to visit ordinary hospitals because of stigma and other mental perceptions of the rest of the American population. The fact the Indians are not fully integrated into the society as manifested by their confinement in reservations could be seen as stigmatizing. This means they need special treatment programs to handle these situations.

However, the needs assessment may not have taken care of those Indians living in urban areas as not all of them are found in or near the reservations. Additionally, the facilities are located majorly in the areas which are perceived to have high concentrations of the Indian population, meaning that those in other regions of the country may not access these services. There is a system in place that defines who an American Indian is, and it may allow Indians within the rest of the population access healthcare offered by the IHS. Even with such a system, the unavailability of the facilities in some places makes the program less effective.

Despite publishing a white paper on health literacy, it is not yet clear whether or not the organization has or intends to develop health communications. The healthcare program is founded on the broad categorization of American Indians and the health issues they face. The intervention practices involve medication for those already displaying the symptoms of the illness. Even the behavioral health services which are intended to address those illnesses caused by individual’s deeds are only cures rather than protective. That means the IHS’s focus on healthcare facilities has been associated with less attention to healthcare communication.

The organization’s website, however, has posted a topic on health communications explaining how this practice needs to be adjusted to the cultural needs. The tools highlighted include internet access, plain-language guidance, health literacy, education materials, and patient-provider communication toolkit. However, there is no indication that it indeed uses these tools, in which case it can be argued that they are mere suggestions. The fact that the organization is aware of these tools could be used to mean that they form part of its mode of operation.

It can be argued, however, that the specific programs tend to target the most vulnerable members of the community. For instance, the purchased/referred care is limited only to groups who meet predetermined criteria, which are intended to ensure only the most vulnerable qualify for coverage. Specialized programs, such as special diabetes one and behavioral health services, are examples of the efforts to serve the most vulnerable among the American Indians.

Cultural Competence Plan

As mentioned above, cultural competency is growing in significance in the healthcare industry as practitioners acknowledge the need to serve culturally diverse populations. This concept has been defined as a developmental process that pursues the capacity to address the specific needs of populations culturally different from the mainstream population (Beaulieu et al., 2019). A cultural competence plan entails the strategies designed to address the cultural concerns of people. The IHS, however, does not have a clearly defined cultural competence plan for solving the cultural aspects of the Indian healthcare challenges.

However, it should be appreciated that the program fully integrates the concept of cultural competence in its practices as reflected in cultural competence webinars and culturally competence best practices posted on its website. Just as in the case of health communications described above, there is hardly any evidence to show how a cultural competence plan is deployed.

The question of what is included in the cultural competence plan cannot be answered unless one such plan is visible. However, the general mode of operation of the company consists of staff training on cultural matters. This aspect can be regarded as staff development. The use of demographic information is also apparent, for example, the specific definition of the American Indian or Native American, which is used as the qualifying criteria (Indian Health Service, 2016). The lack of an expressed statement does not mean, therefore, that the organization does not have these strategies.

Reflection

The analysis presented above reveals that it is not easy to implement culturally competent care, even for specialized health programs. However, the IHS is specifically designed to address the cultural factors of a clearly defined subpopulation. In essence, therefore, cultural competence is the foundation of such a program. The IHS has designed multiple services, all of which serve those needs established through a needs assessment.

From the current understanding, the general healthcare system is relatively inflexible to handle this concept. In a country such as the United States with hundreds or thousands of norms, no single employee can be made to understand the special needs of each of the traditions to offer culturally competent care. Specialized programs, however, are easier to pursue because their focus and scope are only specialized in a particular tribe. However, there are hundreds of Indian tribes across the United States, even though they are all generally categorized as one. The use of Indian personnel across the faculties and the staff training programs should handle any differences. The success of this program, it is understood, should lay a foundation for other healthcare services in the country in their pursuit of cultural competence.

References

Asante-Muhammad, D., & Ramirez, K. (2019). The economic reality of the Native Americans and the need for immediate repair. National Community Reinvestment Coalition. Web.

Beaulieu, L., Addington, J., & Almeida, D. (2019). Behavioral analysts’ training and practices regarding cultural diversity: The case for culturally competent care. Behavior Analysis in Practice, 12(3), 557−575. Web.

Congressional Research Service. (2016). The Indian Health Service (IHS): An overview. Web.

Dennis, M., & Momper, S. (2016). An American Indian health clinic’s response to a community needs assessment. American Indian and Alaska Native Mental Health Research, 23(5), 15−33. Web.

Wilson, V., & Mokhiber, Z. (2017). 2016 ACS shows stubbornly high Native American poverty and different degrees of economic well-being for Asian ethnic groups. Economic Policy Institute. Web.

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