Chapter 5
Managing Diversity  TOP

Introduction

One of the greatest challenges in planning an HIV/AIDS service delivery system under the CARE Act is managing the diversity and representative planning process required by the legislation. Managing a multicultural process can be approached on two levels: organizational and individual membership. On the former, this entails attention to planning processes like meeting rules and policies. Individually, approaches to recruitment of new members and orienting them once they join can enhance a smoothly functioning planning group. The ideal outcome, of course, is creation of programs that better meet the diverse needs of persons living with HIV disease (PLWH).

Legislative Background  TOP

Consortia Requirements

Section 2613(a)(1) of the CARE Act defines a consortium as “an association of one or more public, and one or more nonprofit private, (or private for-profit providers or organizations if such entities are the only available providers of quality HIV care in the area) health care and support service providers and community based organizations operating within areas determined by the State to be most affected by HIV disease;”

Section 2613(c) requires a consortium to submit an application to the State that, in part:

“(A) demonstrates that the consortium includes agencies and community-based organizations—

(i) with a record of service to populations and subpopulations with HIV disease requiring care within the community to be served; and

(ii) that are representative of populations and subpopulations reflecting the local incidence of HIV and that are located in areas in which such populations reside;”

Section 2613(c) requires a consortium to submit an application to the State that, in part:

“(B) demonstrates that the consortium has carried out an assessment of service needs within the geographic area to be served and, after consultation with the entities described in paragraph (2), has established a plan to ensure the delivery of services to meet such identified needs that shall include [in part]—

(iv) assurances that the assessment of service needs and the planning of the delivery of services will include participation by individuals with HIV disease;”

“(2) Consultation.—In establishing the plan required under paragraph (1)(B), the consortium shall consult with—

(A)(i) the public health agency that provides or supports ambulatory and outpatient HIV-related health care services within the geographic area to be served; or

(ii) in the case of a public health agency that does not directly provide such HIV-related health care services such agency shall consult with an entity or entities that directly provide ambulatory and outpatient HIV-related health care services within the geographic area to be served;

(B) not less than one community-based organization that is organized solely for the purpose of providing HIV-related support services to individuals with HIV disease;

(C) grantees under section 2671, or, if none are operating in the area, representatives in the area of organizations with a history of serving children, youth, women, and families living with HIV; and

(D) the types of entities described in section 2602(b)(2).

The organization to be consulted under subparagraph (B) shall be at the discretion of the applicant consortium.”

State Requirements

Section 2617(a) requires States to submit Title II applications that contain requirements outlined in the legislation and the annual program guidance. Section 2617(b) requires applications to contain [in part]:

“(5) an assurance that the public health agency administering the grant for the State will periodically convene a meeting of individuals with HIV disease, representatives of grantees under each part under this title, providers, and public agency representatives for the purpose of developing a statewide coordinated statement of need; and

(6) an assurance by the State that—

(A) the public health agency that is administering the grant for the State engages in a public advisory planning process, including public hearings, that includes the participants under paragraph (5), and the types of entities described in section 2602(b)(2), in developing the comprehensive plan under paragraph (4) and commenting on the implementation of such plan;”

The Challenge  TOP

Membership in a planning body should reflect the demographics of the HIV/AIDS epidemic at the local level. This requires active recruitment of people who represent diverse perspectives, such as race, culture, ethnic background, gender identity, sexual orientation, age, class, education, economic level, geography, risk for HIV, and physical ability. Also essential is securing a membership reflective of different sectors and organizations in the community.

Recruiting the range of people that comprise an appropriately diverse planning body is most certainly challenging. Further, learning to communicate within a diverse environment means understanding that there will be differences among people in the following areas:

• Attitudes and values
• Social organization
• Patterns of thought
• Role assignment
• Language
• Use and organization of space
• Time concepts, and
• Nonverbal expression.

Understanding what those differences mean and how they manifest in the behaviors of participants is another step in managing diversity. Integrating diverse values, norms, vocabulary, and rules into the activities of the group further moves everyone along the spectrum toward multicultural competency.

Multicultural Competence Continuum  TOP

Developing multicultural competence helps you to communicate and to interact effectively and positively with diverse individuals and groups in a diverse society. The multicultural competence continuum below shows a series of steps that define levels of awareness, sensitivity, and competence in dealing with people of various cultures.

Cultural Destructiveness

Making people fit the same cultural pattern, and excluding those who do not fit; forced assimilation. Emphasis on using differences as barriers.

Cultural Blindness

Not seeing or believing there are cultural differences among people; “everyone is the same.”

Cultural Awareness

Being aware that we live and function within a culture of our own and that our identity is shaped by it.

Cultural Sensitivity

Knowing that there are cultural differences and understanding and accepting different cultural values, attitudes, and behaviors.

Multicultural Competence

Having the capacity to communicate and interact effectively with culturally diverse people, integrating elements of their culture, vocabulary, values, attitudes, rules, and norms. Translation of knowledge into action.

Definitions become critical as groups attempt to understand their diversity. We all have values, act on stereotypes, hold prejudices and—usually unwittingly— practice discriminatory behavior. The key is acknowledging the existence of values, stereotypes, prejudices, and discrimination, and then being willing to change.

The following definitions are offered as a place to begin:

The following are basic steps in successfully managing diversity:

• Accept that there are differences
• Learn exactly what those differences are and how they manifest themselves
• Move beyond being aware and sensitive to the differences and start respecting and valuing them, and
• Integrate the differences into models, structures, policies, and procedures that are comfortable and appropriate for all participants, at all levels of the Title II process.

Culturally Competent Organization  TOP

A planning body should examine all aspects of its organization in terms of embracing and promoting diversity. Commitment to a diverse membership means that all aspects of the way the planning body conducts its business should be examined for how well they foster the comfort of all participants. If one culture or group’s values dominate, the membership tends to reflect only that one group or culture. Other cultures and groups do not feel comfortable, do not participate, do not feel valued, and are often treated as tokens. All aspects of a planning body should reflect the values and norms of its diverse membership, from the way meetings are run to the language used to write policies and procedures. Diversity will not happen simply because diverse participants are invited to attend a meeting. The culture of the group must reflect commitment to competently managing diversity. All parts of the planning body must be examined and changed when necessary to create an environment that promotes a diverse team. The make-up of the group will ultimately reflect the quality of the resulting planning and programs.

The following elements need to be examined for cultural competency:

• Membership recruitment
• Orientation of new members
• Meeting locations and times
• Meeting process and rules of interaction
• Leadership
• Committees, and
• Policies and procedures documents.

Below is a list of questions for each of these areas that can be used as a checklist to evaluate how well diversity is being managed.

Membership Recruitment

Assess the cultural competency of membership recruitment by asking the following:

• Is there a formal policy for recruiting members which reflect the diversity in the community?
• Is the committee that is responsible for membership recruitment diverse enough?
• Have key contacts and leaders from all the targeted communities been identified and contacted?
• Have the different community leaders been asked specifically about the best way to solicit input and new members from their communities?
• Is there a membership recruitment plan which has been used by the consortium?
• Does the membership recruitment plan offer different strategies for reaching each targeted community?
• Are the outreach materials culturally and linguistically appropriate?

Orientation of New Members

Examine the cultural competency of new member orientation by asking the following questions:

• Is there a formal interactive orientation as well as written materials?
• Is there a mentoring program?
• Are the written materials culturally and linguistically appropriate?
• Are specific roles, responsibilities, and member job descriptions identified and articulated?
• Is the orientation conducted by members who are culturally competent?

Meeting Locations and Times

A failure to consider the needs of all members when setting meeting locations and times can limit the full participation of some. To determine how well diversity is being managed in terms of meeting arrangements, ask the following:

• Are the meetings held in locations that are comfortable to all participants?
• Are the meeting times appropriate to the most diverse membership possible?

Meeting Process and Rules of Interaction

Formal and informal ways of interacting at meetings and around decision making should be examined to make sure all members are comfortable with procedures and expectations. Ask the following:

• Are the meeting rules clearly understood by all members?
• Is the meeting process simple, written down, and understood by all members?
• Do members have the opportunity to be involved in discussions about any changes in the meeting process?
• Is the meeting process periodically evaluated by the members?
• Are the methods of changing the meeting process clearly communicated in writing?
• Is the meeting environment friendly and open?
• Is the style of running the meetings comfortable to most participants?
• Are all members comfortable with the way decisions are made?

Leadership

A culturally competent approach to leadership aims to open leadership positions to a diverse set of members. Ask the following questions:

• Is there a formal leadership development or mentoring program that specifically encourages diversity?
• Are leaders offered training?
• Has shared leadership been considered to encourage diversity (e.g., co-chairs or chair-elect)?

Committees

Committees must be open and accessible to diverse membership in order to foster the cultural competence of the whole group. Ask the following questions:

• Is committee leadership by members from diverse communities encouraged?
• Do committees meet in locations and at times that are comfortable for all members?
• Do committees welcome members who are not members of the consortium?
• Is the mission of the committee clearly understood by all members?
• Are all committee members given specific tasks to perform?
• Is there a committee workplan to meet its goals and objectives?

Policies and Procedures Documents

Written policies and procedures reflect how well the group incorporates diversity. The following questions can be asked:

• Are the policies and procedures written in a straightforward style?
• Do all members have the opportunity to participate in the development and approval of any changes in the policies and procedures?
• Do all members have a complete set of all the policies and procedures?
• Is the method for making changes in policies and procedures clearly understood by all members?
• Are the policies and procedures periodically evaluated?
• Are the policies and procedures followed?

Approaches for Individuals in Groups with Diverse Membership

The following are some ways individual members can learn to work together as part of a diverse team:

• Pay attention to what others are saying to you.
• If someone is bothered by the actions of another group member, look for a way to address his or her concerns and resolve the problem.
• Treat everyone with the same level of respect, showing your recognition that everyone has equal rights.
• Learn about and welcome diversity; if your initial reaction to differences is negative, ask yourself if that reaction is due to fear of the unfamiliar.
• Do not engage nor condone intolerant behavior within the group; do not make jokes or stereotype individuals, and do not permit others to do so.
• Verbally and publicly support other members of the consortium in situations where outsiders fail to show respect.
• Discuss problems and try to explain your perspective; do not ignore concerns or problems.
• Talk about problems and concerns directly with the other person(s) involved, not behind their backs.
• If you cannot resolve a problem directly, seek a mediator.
• Do not make excuses if you are having trouble getting along with someone different from you.
• Ask for help.

REFERENCES  TOP

Mosaica: The Center for Nonprofit Development and Pluralism, for The Corporation for National Service Training and Technical Assistance Unit. “Diversity and Multiculturalism.” Starting Strong: A Guide to Pre-Service Training.” August 1996.