Providing Culturally Congruent Care

Outreach

Many times, sexual assault victims are unaware of the resources that exist within their communities or may think the services are not relevant to their needs or accessible.⁷ In other cases, communities do not realize what their citizens need.

Know Your Community

An attorney with the Civil Rights Division at the U.S. Department of Justice moved to Kansas City, Missouri, to become a U.S. Attorney, and human trafficking was not on the district's radar. The attorney met with all of the local law enforcement agencies and explained the Trafficking Victims Protection Act. Law enforcement officials began to realize that they had seen the signs of trafficking without knowing it. After a robust outreach campaign to educate law enforcement and the community, a human trafficking task force was established.

Begin your outreach efforts with an appreciation for the following:⁸

• Age: Includes the perspectives and belief systems of differing generations.
• Ethnicity/race: Includes perspectives related to specific racial and ethnic groups and subgroups. These perspectives include group identification, color, and cultural practices that may or may not support sexual assault intervention and prevention efforts.⁹
• Immigration/citizenship status: Includes the citizenship status of individuals who are refugees, migrants, asylum seekers, immigrants, and victims who came to the United States as tourists, students, or employees and stayed beyond the expiration date of their visas. The length of time an immigrant spends in this country does not necessarily lend itself to acculturation. The emigration experience, as well as trauma or oppression experienced in the native country prior to emigration, may affect a person's sense of vulnerability, trust in others, and behaviors.¹⁰
• Beliefs: Includes victims' understanding about what is considered criminal and what causes crime. To improve service delivery, it is crucial to understand victims' specific belief systems about healing and justice.¹¹
• Religious/cultural practices: Includes victims' perspectives on gender roles, the definition of justice, and faith-based practices and rituals.
• Health status: Includes the health status of individuals who have a range of physical and mental health conditions such as diabetes, high blood pressure, breast cancer, HIV/AIDS, schizophrenia, depression, and substance abuse. This category also may include uninsured and medically underserved victims.
• Individuals with disabilities: Includes access to services for individuals with physical, sensory, or mental disabilities, or a combination thereof. Physical disabilities may result from injury (e.g., spinal cord injury, amputation), chronic disease (e.g., multiple sclerosis, rheumatoid arthritis), or congenital disabilities that include hearing or visual loss. Mental disabilities include developmental conditions (e.g., intellectual disabilities), cognitive impairment (e.g., traumatic brain injury), or mental illness.
• Sexual orientation/identity: Includes lesbian, gay, bisexual, queer, intersex, questioning, and transgender individuals and hate crimes associated with victims' sexual identity or perceived identity.
• Language: Includes communication skills, cultural dialects, and accents that support or impede access to services and other resources.¹² The category also includes other recognized forms of language used by individuals to communicate, such as sign language or the use of pictorial images in art therapy.
• Literacy: Includes, but is not limited to, being able to read brochures about the services offered and write notes about an incident shortly after it occurs. Also includes health literacy (the degree to which individuals understand how sexual assault may affect their health).
• Economic status: Includes access to financial and other support, particularly a livable income. This category could include access to shelter/housing, food, clothing, heat, water, phone, transportation, health insurance, quality childcare, and other necessities that could interfere with access to services.¹³
• Social history and previous experiences: Includes the stigma attached to seeking help and beliefs about what characterizes crime. For example, strong adherence to stoicism, family privacy, fear of deportation, or cultural loyalty can run counter to service providers' expectations.¹⁴
• Isolation: Includes individuals in rural areas or impoverished urban areas who are physically or emotionally distanced from support. For example, victims in small communities in remote areas who fear stigma and gossip; individuals with limited or no access to transportation; individuals with limited access to telephones and other communication technology; victims who are isolated by immigration issues such as undocumented status; and victims who are vacationing and away from readily known services.
• Closed and semi-closed communities: Includes individuals residing on federal land, military installations, religious communes, institutions of higher education, nursing homes, and prisons.
• Persons participating in, charged with, or convicted of illegal activities: Includes victims who are incarcerated, convicted of crimes, or charged with crimes. For example, this category can include victims with outstanding warrants or victims participating in illegal activities prior to the assault.

Develop Your Outreach Plan

Meeting the needs of historically underserved communities requires a plan for setting direction, defining results, leveraging new resources, identifying issues, and developing solutions. In 2001, the Violence Against Women State Planning Committee in Hawaii created a long-range plan for increased outreach and services to underserved populations isolated by culture and language, disability, and sexual orientation.¹⁵ The planning committee found that—

• Non-English speaking individuals lacked close ties to and support from family and friends and may have had limited access to and understanding of the services available to them.
• Non-English speaking victims were often isolated geographically, emotionally, and intellectually.
• Intimate partner abuse included various forms of isolation.
• Women were vulnerable in the workplace (e.g., female housekeepers were assaulted while cleaning hotel rooms).
• Victims who were in the military or were military dependent and who lived off-post were isolated from military support services.

To address these issues, the planning committee set two objectives:

• Increase outreach to victims isolated by culture/language, disability, and sexual orientation.
• Meet with knowledgeable people in underserved groups and determine effective outreach activities.
• Develop outreach campaigns with and for underserved populations.
• Develop training components to address cultural sensitivity.
• Define a minimum level of services to ensure continuity of victim services.
• Implement outreach campaigns with and for underserved populations.
• Expand/implement collaborations with criminal justice system partners.
• Develop and implement a strategy to ensure that victim services are sustainable. Provide a balanced system and level of services that extend beyond the current services. As a contingency plan, train volunteers to maintain services if funding decreases.  

• Increase accessibility to law enforcement, courts, and service providers.
• Increase the number of competent interpreters (i.e., competent in sexual assault issues, policy, and procedures of the court system).
• Develop cross-cultural training curriculums for law enforcement, courts, and service providers and include victims in the planning process.
• Provide competent interpreters as defined above for all victims.
• Provide sensitivity training to law enforcement, courts, and service providers.
• Provide reasonable accommodations to make services accessible to victims who need additional support to access services, such as transportation to treatment or court.

Hawaii's plan for increased outreach and services is an example of a culturally sensitive system of care. As you endeavor to build such systems of care, keep in mind the following:

• Victims who come from particular cultural groups do not necessarily share the values commonly attributed to that group. There is as much diversity within cultures as there is between cultures.
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In This Toolkit: Create a Strategic Plan

• The terms "diversity" and "traditionally underrepresented" are often used interchangeably but there are differences. Diversity refers to ethnicity, race, sexual identity, gender, and so forth and accounts for differences within each group.¹⁶ Traditionally underrepresented or underserved refers to persons whose distinct experiences and needs have not been generally recognized or have not been well-served by organizations that respond to sexual violence.¹⁷