EXECUTIVE SUMMARY

One challenge that case managers sometimes encounter involves caring for patients from an unfamiliar culture. One case management organization developed tools to help with these circumstances.

• IPMG of West Lafayette, IN, formed a culture work group that divided into four subgroups: family, aging, language, sexuality.

• Each subgroup develops guides and information to assist case managers when they work with families where cultural barriers might exist.

• The main goal is to teach case managers how to respect different cultures and to help them avoid being put into awkward situations.


Case managers visiting homes of clients and their families sometimes have questions related to uncertain encounters: “How am I supposed to dress?” or “Someone from another culture is always offering me food, and we’re not supposed to take food, so what do I do?”

Supervisors did not have ready answers to these questions, so the solution was to develop a committee to look into culture issues and solutions for various situations, says Michele Phillips, assistant director, case management operations at IPMG of West Lafayette, IN. IPMG’s case managers work with people who have intellectual and developmental disabilities.

Northwestern Indiana is culturally diverse, including Amish culture, Japanese families, and other nationalities. As the cultural committee worked and researched, they expanded the definition of “culture” to include people with hearing difficulty, she says.

“We asked people who might be interested in looking at different cultures to pick the top five or six cultures we were getting questions about,” Phillips says.

After researching local cultures, the group asked case managers for feedback.

“We asked, ‘What could be offensive, and what could we do to make things better?’” she explains.

The executive director suggested turning the committee into a work group consisting of one representative from each of the organization’s 16 geographical groups across the state. “We have 16 people on the committee — one for each group,” Phillips says.

Phillips and the executive director also are part of the work group, helping fill in gaps when needed. They also facilitate discussions, review notes, and review guides and templates before they are finalized and presented to the company, she says.

The culture work group communicates via electronic announcements between meetings. The group also was divided into subgroups of family, aging, language, and sexuality. When case managers have a cultural question, they send it to the subgroup that aligns with that concern.

“The subgroup starts with initial research to find out what answers the organization already has in place and that might be relevant,” Phillips says. “We look at what we run across from research we’ve done in other areas.”

For example, a group member might ask peers, “I’m working on a template for complementary medical practices like Chinese medicine, acupuncture, and chiropractic care. Do you have anybody who does this or know of anybody who participates in this?” Phillips says.

The culture working committee’s subgroups handle questions from case managers and develop guides that talk about cultural groups and their characteristics, and what case managers might encounter, she says.

“They include techniques and strategies that work well and list resources for additional information about a particular cultural group,” she adds.

The following are the subgroups and the cultural issues they cover:

• Family. One recent discussion was on navigating strained family dynamics. “We’re working on how case management can work with parents who are divorced,” Phillips says.

The family subgroup also has discussed how families sometimes choose nontraditional medical practices, including Chinese medicine and acupuncture, as an alternative to traditional medical care.

Rural issues, such as accessing healthcare in remote areas, also affect families, she says.

“Right now, the family subgroup is working on supportive decision-making, which is an alternative to guardianship,” Phillips says. “We’ve been interested in that topic, and the state of Indiana is moving toward supportive decision-making.”

Such decision-making gives disabled individuals the opportunity to make decisions about their lives and medical care while receiving guidance from a care team.

• Aging. This subgroup discusses older individuals and how to work with them on future planning. The planning can include healthcare representatives, medical power of attorney, and guardianship.

The aging subgroup helps case managers understand that with older patients, they might need to take more time and work with the client and someone who can assist the client. The group developed a guide to explain Do Not Resuscitate.

• Language. “We have worked on documents translated into Spanish, and we’ve done a lot of work with resources for people who work with individuals who are deaf or hard of hearing,” Phillips says.

The subgroup also has researched translation apps, which can help people working with non-English-speaking patients and families.

“We did demonstrations of translation apps, where case managers can use their own phones,” she says.

• Sexuality. The subgroup discusses lesbian, gay, bisexual, or transgender (LGBT) topics and brings in speakers who address issues that can arise with LGBT patients and families that include an LGBT person, Phillips says.

“Our guidance is on how to support people who want to come out and how to support people who may want to talk with others about being transgender,” she says. “We’re working on a resource for financial, legal, and medical ramifications for people who want to go through the process of changing their identities.”

Case managers have dealt with this population among their clients and families, she notes.

“Having a disability doesn’t change how someone feels in regard to their sexuality,” Phillips says.

There also is a guide about Amish families, which was developed before the subgroup topics were chosen. “We received a lot of questions about Amish families because there’s a large Amish community in Northeastern Indiana,” Phillips says.

The advice on how a case manager should dress when visiting an Amish family was to be modest and be themselves but avoid short skirts, cleavage, and visible tattoos, she adds.

Case managers have reported that the guidance is very helpful, and they like giving the culture team feedback on what to include and update, Phillips says.

“We need to be willing to be respectful of different cultures, and I think we are showing our case managers that we respect their rules and don’t want to put them into uncomfortable situations,” she says.