https://doi.org/10.1177/1555458919870564

Journal of Cases in Educational Leadership 2019, Vol. 22(4) 99 –114

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Article

Cultural Proficiency: The Missing Link to Student Learning

Corinne Brion1

Abstract This case illustrates why school leaders must be culturally proficient to serve all students and lead effectively. I discuss one case in Ohio that is representative of many other American schools. In particular, I examine the cultural challenges educational leaders must commonly face. This case encourages administrators to participate in meaningful conversations with stakeholders to solve complex issues. The hope is to better understand how school leaders in diverse contexts can lead and embrace different cultures, beliefs, and norms. I also pose questions designed to prepare educational leaders for similar situations where they must address issues of culture.

Keywords cultural proficiency, cultural blindness, educational leadership, diversity, equity

Introduction

The Sustainable Development Goals (SDGs), developed by the United Nations in 2015, aim at transforming the world by achieving quality education for all students globally, regardless of their race, ethnicity, gender, socioeconomic status, age, sexual orientation, abilities, or religion (United Nations, 2016). Because of recent economic hardships and changes in the sociopolitical contexts of various countries, there has been an increase in human migrations. This new demographic makeover has resulted in more diversity in our communities, schools, and universities. As a result of this increase in diversity, preparing aspiring teachers and educational leaders to be cultur- ally competent should be a priority. If educational leaders are culturally competent,

1University of Dayton, OH, USA

Corresponding Author: Corinne Brion, University of Dayton, 300 College Park Fitz Hall Dayton, OH 45469 USA. Email: [email protected]

870564 JELXXX10.1177/1555458919870564Journal of Cases in Educational LeadershipBrion research-article2019

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they will overtime alter their students’ mindsets, reactions, and actions. As new gen- erations of students benefit from a more inclusive education, they will model and formally or informally teach cultural competency and respect to others.

Some educational leadership programs lack coherence and utility by continuing to offer the “classic” courses such as school law, school finance, organizational theory, and principalship without addressing current educational needs and changes (Hackmann & McCarthy, 2011). However, because leadership standards call for educational leaders to be equitable and culturally responsive, researchers have found an increase in pro- grams offering new content such as ethics, cultural foundations, and social justice (Marshall & Olivia, 2006; McCarthy, 2015). The University Council for Educational Administration (UCEA) led the charge to review leadership programmatic content and make recommendations for adaptation and change. Despite UCEA’s curriculum recom- mendations, there are still programs in American states that continue to only offer the classic courses without taking into consideration the role culture plays in teaching, learning, curriculum, and extracurricular activities. As a result, some school leaders are ill prepared to do their job effectively and provide an equitable education for all. This case study raises issues related to the lack of cultural awareness among school leaders and its impact on students, school, and communities.

Background Information

Dayton, Ohio

Dayton is a medium size city in Ohio, USA. Between the 1940s and 1970s, Dayton was a wealthy city offering employment opportunities in the automobile and technol- ogy industries. In the 1980s, however, because large companies such as National Cash Register left the area and because of the housing crisis, the city experienced high rates of unemployment and a massive decline in its population. Between 2000 and 2010, the general population of Dayton decreased by nearly 15%; yet, the foreign-born popula- tion increased by more than 50%, making Dayton with the largest percentage increase in its foreign-born population arriving since 2000. Immigrants from over 100 call Dayton home.

With a depressed economy, the city saw an increase in drug addictions and crimes related to it. As it is the case in many American cities, a river separates the “good” and “safe” part of towns from the “undesirable ones.” Since redlining occurred, the Miami River has historically served as a natural separation between races, economic status levels, and access to opportunities. In the 1930s, surveyors with the federal Home Owners’ Loan Corporation drew lines on maps and used the color red for some neigh- borhoods, deeming them “hazardous” for bank lending because of the presence of African Americans or European immigrants, especially Jews. As a result of relining, the city is highly segregated. Although redlining has been outlawed since 1968, the practice is still alive and well in Dayton today. Less real estate mortgages are given to the residents located on the West side of the river. As West side residents say, “All things on the west side of the river suffer” (see Daytondailynews.com). Currently, Dayton and its county are 42% African American.

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Welcome Dayton

The United States has a history of welcoming and rejecting new people. The com- plaints heard historically are as follows: “They will take our jobs,” “they won’t inte- grate in our culture,” or “they don’t want to learn English.” Similar comments are made today about immigrants. Welcome Dayton is an initiative led by the City to welcome and assist immigrants and refugees. The goal of this program is to reduce barriers to business development, increase participation in government, easing access to social services, and reducing the risk of employers taking advantage of new immi- grants (Welcome Dayton, 2011). The city offers English classes, sports events, health resources, mentorships, and help families get to get settled (Welcome Dayton, 2011).

Dayton School District

The Dayton School District serves 12,000 students from Kindergarten to High School. The district gained an F on its 2017 report card. Although the district is committed to improvement, the Ohio Department of Education provided the district with several recommendations for greater impact. ODE states,

Although the district has employed new personnel in key leadership positions at the district and school levels, there is a lack of adequate training, development and consistent support structures for these leaders to effectively fulfill their responsibilities. Also, the district lacks a successful system that ensures continuity in key leadership positions in order to support and sustain turnaround work over time. Finally, staff attendance is low at professional development offered by the district.

Dayton High School (DHS)

DHS is a fictitious school. The school is located on the West side of Dayton. The com- munity surrounding the school is deprived of stores, community centers, and super- markets and has been labeled as a food desert, which means that people residing near the school have to walk, drive, or take the bus for over 3 miles before finding a super- market. The school facility sits on several acres of land, which allow for ample space for a sport facility, have large classrooms, and a career technology center. The career technology center offers programs in communication, business, health, automotive, engineering, and construction. Because of the school district push to educate for employment, this program is well attended and has received the attention of numerous local sponsorships and donations.

The school’s mission is “To provide a quality education to all students using a holistic curriculum that prepares students to succeed in the professional and personal lives.” DHS serves 1,200 students, 40% of these students are boys and 60% are girls. Of the 160 boys, 30% are White and 70% are Black, and out of the 240 girls, 32% are White and 68% are Black. Looking at the demographic data, about half of the Black population is composed of African American while the other half are from Congo and

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Eritrea where massive conflicts have forced locals to flee and seek refugee status in other countries.

The school employs 25 full-time teachers, three special education teachers, two assistant principals, two janitors, three cooks, two bus drivers, two secretaries, one assistant in charge of discipline, one accountant, and one counselor. Teachers are almost equally represented in terms of gender; however, 90% of the teachers and administrative staff are White. One janitor is Black and the other is Hispanic.

The Principal

Mrs. Collins (fictitious character) is the current school principal. She is starting her second year in her role. The school has had five different principals in the 5 years preceding her appointment. Mrs. Collins is originally from a small town in Ohio. She received a master’s degree in Education and a minor in French from an online univer- sity. She chose the online option because it was more affordable than other programs. Another reason for her choice was that the leadership preparation program could be completed in 8 months. She used to be a teacher and an assistant principal in a primary public school in a small town in South East Ohio, where there was little diversity, drug issues, or crimes. It is her first time leading a large high school with a diverse popula- tion. She inherited the school when it was about to be taken over by the State for poor academic performance and consistently receiving an F on the school’s report card. This year, Mrs. Collins was given an ultimatum, to show progress in the academic achievement or to be taken over by the state and possibly lose her job.

Under pressure, Mrs. Collins and her team looked at her academic, demographic, and discipline data. The team noticed an elevated number of office referrals and deten- tions among Black students and a growing achievement gap between White and Black students. The principal also witnessed more fights among students and a higher per- centage of absenteeism than in previous years. As a result of the poor academic achievement and discipline concerns, teachers do not stay at DHS, they often ask to be moved to other institutions. This case study raises issues related to leadership and cultural competency.

The Case

Mrs. Collins learned early on in her career to base her decisions on data. She had learned this lesson the hard way when she was an assistant principal and had to make decisions on professional development and budget allocations. At the end of each semester, Mrs. Collins has been reviewing the discipline data with the teachers and administrators. Lately, the administrative team has noticed a significant increase of referrals for Black students, males in particular. Surfacing this new issue has caused unrest among teachers and staff. In addition to disparities in the discipline data, the achievement gap is now showing, with White students performing at higher levels in Mathematics and English. Worried about losing the school, Mrs. Collins decided to tackle the discipline issue and try a new strategy.

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One day at a faculty meeting, Mrs. Collins came with a solution: “From now on, you keep the students in class unless the student endangers his/her life or the lives of others.” Not having much time to think about the issue further, the teachers eagerly accepted the proposed solution. The following week as Mrs. Collins was passing by the classrooms, she heard an unusual amount of noise. She was certain that it had to do with one of the project-based learning activities that the teachers regularly conducted. To her dismay, when she approached the class, she saw two teenagers at each side of the teacher, getting ready to hit each other. She immediately paged the office to ask for the school security. Both students were sent to the office but after careful consider- ation, the White student was released to the class while the Black student was inter- rogated further. During the discussion, the student lost his temper and yelled, “It is not fair, we always pay for what the White kids start.” Shocked, the principal replied, “What do you mean?” The student in tears answered: “Don’t you see that no one ever truly cares to ask us our version, no one ever truly listens.” The student added,

The new teachers in Math and English are nice but they never let us speak in class. It is like they do not know us and do not try to know us or understand us and our culture. Nobody does! They also make us group with other Blacks, so we never have a chance to work with the White kids. It is obvious that they prefer Whites. But I am not poor, I am not dumb, my skin is just black.

Feeling empowered to talk, another Black student who was serving detention near Mrs. Collins’s office and had heard about the commotion said,

Because of the community spirit that guide our culture, we like to help others and that is when sometimes the teachers catch us. You see, to them we are noisy when we just are helping and talking in class. We are brothers and sisters and we would help anyone Black or White. Teachers seem afraid to give us the physical and mental space we need to succeed. Instead we serve detentions.

So much honesty and bluntness surprised the principal. She decided to call an emer- gency faculty meeting that afternoon. During the meeting, the White teachers blamed the students for the incident and claimed, “These students always act up”; “The issue is not us; it is them”; and “We treat every student the same.” When Mrs. Collins looked around the room, she saw teachers acquiescing and agreeing with what had just been said. She felt reassured and thought “ok if everyone feels that way, the issue must reside with the students then.”

Simultaneously, parents of the students serving detentions started to complain that their children were telling them about the regular incidents between students and teachers. Some parents threatened to withdraw their children because “this school is damaging to my child self-esteem it is not worth going to school.” Community members also threat- ened to retrieve their donations and sponsorships if students continued to perform poorly academically and spend time in detentions. Mrs. Collins once again was perplexed and had no good answer. The district also questioned Mrs. Collins practices as they heard about the increasing numbers of detentions. Mrs. Collins did not know what to do. She had not been prepared to work in an urban district and dealing with diversity.

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Halloween season came around, Mrs. Collins was touring the school and heard chaos, as the students were preparing for a Halloween classroom parties. While the White and African American students were actively preparing their costumes, the students from Africa had a stern look on their faces. “What is the matter?” she asked one student:

Mrs. Collins, it is so strange to have to celebrate the death of people with scary costumes and skeleton. In my religion and culture, this is disrespectful, and I do not want to participate because my mother would not approve. Nobody ever asks us about the festivals we would like to celebrate, everyone just assumes that it will be fun for us because it is fun for some of the others.

Mrs. Collins did not understand how Halloween could not be a fun day and how it could offend students. After this interaction with the student, she went to find her assistant principals and explained to them what the student had just said. Their reac- tions were much like hers. At the teacher-based team meetings that day, Mrs. Collins chose to share the Halloween story to seek teachers’ perspectives on the incident. Teachers shared that they were “not surprised with these students. How can they understand Halloween when they hardly speak English, just moved to this country and do not fit in our school.” One teacher added, “We are not equipped to accommodate refugees here and because of their poor language skills, they bring our scores down.” After the meeting, Mrs. Collins felt dizzy and thought to herself: “How can I focus on student achievement when my days are spent putting out fires that have nothing to do with academics.”

Besides race and ethnic differences, the school experienced differences in abilities, religion, and sexual orientation. Data started to show a high level of absenteeism among a few students. Curious as to why these handful of students were missing school so frequently, Mrs. talked to the counselor. The counselor admitted that these students were uncertain of their sexuality and did not feel comfortable at school because other students often made fun of them, threatened them, and called them names. The counselor shared with the principal that students felt unsafe in the bath- rooms and were not understanding why the bathrooms had to be only for students and staff identifying as boys or girls. One student said,

I am not sure where I fit in the school because of my transgender identity. Just to go to the bathroom has become such an ordeal, I would rather not come to school than dealing with more aggression. I already get that at home.

Bullying because of race, abilities, religion, or sexual orientation was now common practice at DHS. Mrs. Collins was lost and felt inadequate in her role. She had spent considerable time, resources, and money on professional development for teachers to better use technology and make their classroom more interactive. She had thought that with better technology and infrastructure, the school would yield better academic results. Instead, the school was getting closer to being taken over by the state, with wider achievement gaps, higher levels of detentions and absenteeism as well as disil- lusioned parent body and community members. Mrs. Collins made decisions for the

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school without understanding her students’ cultures and needs. Her lack of cultural awareness also alienated some of the parent community.

Teaching Notes

In this case study, the school principal faced numerous challenges including leading a school with a wide diversity of students, an increase of student referrals, absenteeism, and achievement gap due to cultural blindness. The following teaching notes will help you further your understanding on these key concepts.

Educational Leaders as Change Agents

“Education is an important tool for the development of an individual, society and the nation at large” (Edet & Ekegre, 2010, p. 1). Seminal scholars argue that head teachers play a crucial role in the education of children because they influence teacher morale, retention, and student learning (Grissom & Harrington, 2010; Ingersoll, 2001; Marzano, Waters, & McNulty, 2005; Rosenholtz & Simpson, 1990). Leithwood and Jantzi (2008) suggest that educational leaders empower the more effective teachers and that it is through them that they improve student learn- ing. Additional scholars maintain that leaders create cultures of learning and those cultures positively affect student learning (Amedome, 2018; Donkor, 2015; Fullan & Hargreaves, 1991).

The culturally proficiency framework. To aspire to become culturally proficient, it is helpful to use Lindsey, Nuri-Robins, Terrel, and Lindsey’s (2018) cultural proficiency framework (Appendix A). According to the authors, being culturally proficient requires people to be vulnerable, curious, humble courageous, open, and reflective. The cultural proficiency framework is composed of four tools, one of which are nine guiding principles that serve as core values:

•• Culture is a predominant force in society. We all belong to cultures. •• People are served in varying degrees by the dominant culture. •• People have group and individual identities. •• Diversity within cultures is vast and varied. •• Each cultural group has unique cultural needs. •• The best of both worlds enhances the capacity of all. •• Schools systems must recognize that marginalized populations have to be at

least bicultural and that this status creates a distinct set of issues to which the system must be equipped to respond.

•• Inherent in cross-cultural interactions are dynamics that must be acknowledged, adjusted to, and accepted.

The cultural proficiency framework offers a second tool, Five Essential Elements of Cultural Competence, that flow from the Guiding Principles and serve as standards

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for personal, professional values, and behaviors as well as organizational policies and practices. The five elements are as follows: assessing cultural knowledge, valuing diversity, managing the dynamics of difference, adapting to diversity, and institution- alizing cultural knowledge. The principal at DHS lacked competency in the five ele- ments resulting in her being culturally blind and leaving her teachers being in the state of blindness as well.

The framework also proposes barriers to cultural proficiency that serve as personal, professional, and institutional impediments to socially just and diverse society by being resistant to change, being unaware of the need to adapt, not acknowledging sys- temic oppression, and benefiting from a sense of privilege and entitlement. At DHS, the leader, and teachers were unaware of the need to adapt and did not acknowledge that systemic conscious or unconscious oppression, due to cultural differences, existed.

The framework also offers a Cultural Proficiency Continuum that portrays people and organizations who possess the knowledge, skills, and moral bearing to distinguish from unhealthy to healthy practices as represented by different worldviews. The Continuum is comprised of six phases: Cultural Destructiveness, Cultural Incapacity, Cultural Blindness, Cultural Precompetence, Cultural Competence, and Cultural Proficiency. The Continuum can be used as an assessment tool to assess where an individual or organization is on the Continuum based on educators’ expressed values and behaviors and schools’ enacted policies and practices.

Cultural Destructiveness is characterized by individuals who see the differences in cultures and stomp them out. Cultural destructiveness often involves macro aggres- sions. Extreme examples are genocides, slavery, placing children of First Nations people, and put them in boarding school where the goal was to eradicate their language and culture.

Cultural Incapacity is portrayed by extreme bias and belief of superiority of one’s cultures and beliefs. Example can be the belief that being heterosexual is inherently better than homosexual or questioning women or people of color but not doing it for anyone else.

Cultural Blindness is when people see the cultural differences and dismiss them. In this phase, people often say things like: “Color does not exist” and “I do not see colors, I only see and teach students.”

Cultural Precompetence: In the culture Precompetence phase, people recognize what they do not know. This phase is about the awareness of one’s limitations when interacting with other cultures. An example could be hearing teachers say: “We are trying to teach the students who used to teach here, and we are not adapting to the new demographics.”

Cultural Competence: People see the differences and understand, accept, and respect those differences. Examples could be when leaders adopt culturally relevant leadership and/or curriculum, advocate for changes in policies, and so on.

Cultural Proficiency: In this last phase, people the differences, respond positively and affirmingly to differences, advocate, and always learn. A school leader might say, “My role at the school is to make my learning even more important than our students’ learning. That is the only way I can anticipate and respond to the students’ needs.”

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Ignoring cultural issues in schools and organizations present numerous risks includ- ing reinforcing stereotyping, increasing intolerance among the groups, raising poten- tial misunderstandings, escalation of frustrations, and defensiveness and learners’ withdrawals (Williams & Green, 1994). At DHS, Mrs. Collins faced the challenge of moving the school from being culturally blind to being precompetent and realizing individual, collective and institutional gaps in cultural knowledge.

This case study uses the cultural proficiency framework as a theoretical base to raise critical questions relative to the Cultural Proficiency Continuum. Because of events, action or nonactions that are taken along this Continuum, today students from certain racial or socioeconomic groups continue to be denied access to an equitable education (DiAngelo, 2018; Ladson-Billings, 1998, 2004; Parker & Stovall, 2004; Stovall, 2006). These topics are critical for any schools in any contexts but are particu- larly salient when working in settings, where students, teachers, and staff need to work collaboratively despite their differences in race, socioeconomic status, language, reli- gion, values, norms, and beliefs.

Conclusion

The situation at DHS is far from being resolved. Although the district started to offer training on issues related to race and equity, the principal is challenged by teachers unwilling to accept and respect other cultures. Mrs. Collins herself is seeking help to learn more about the cultures of her students and to move to from cultural blindness to cultural precompetence and cultural proficiency. Mrs. Collins still face the possibility of being taken over by the state because changing mindsets takes time and may not be reflected in students’ achievement data for a few years. However, the rise in the absen- teeism and increase in detentions could plummet if the principal’s efforts focused on building a culture of respect, trust, and learning, which requires cultural competencies. This case study is relevant, and its solutions are applicable to many districts in the United States because issues of equity due to the lack of cultural proficiency are per- vasive in this country. DHS highlights how crucial it is to become culturally proficient. To reach the SDGs by 2030 and serve all students, it is imperative that educational leaders take culture into consideration.

The Challenge

Next, you will have the opportunity to reflect on the case study and apply what you have learned. Using the teaching notes, please answer the questions and complete the activity.

Put yourself in Mrs. Collins shoes. What would you do?

Questions to Consider

1. Divide into two groups to discuss why the situation at DHS deteriorated. One group should take the perspective of the leader and teachers and the other

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group discuss as if they were students. Then, share your thoughts with the other group and discuss areas of consensus and dissension.

2. What could have been done to prevent the situation? When should it have been done?

3. Our cultural story drives (consciously or not) our actions and reactions. The story is formed over years of exposure to media, family beliefs and values and is deeply engrained in us. Using the graph below, fill out your cultural story, following the instructions below: ○• Write your name in the center circle. ○• In the outer circles, write the names of five groups with which you identify

(nationality, religion, any other identifiers/cultures to which you belong, hobby?).

○• Choose one primary group and answer. a. Share a time when you felt proud to be a member of that group. b. Share a painful experience resulting from membership in that group. c. Which identify with some degree of personal privilege?

○• Discuss your circles and answers with a partner.

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4. As current and future leaders, are you prepared to handle situations related to cultural differences? In what ways (a) are you prepared and (b) feel unprepared?

5. Using the Five Elements of Cultural Competence by Lindsey et al., brainstorm and discuss with a partner: ○• What can you do to assess your cultural knowledge? ○• How can you value diversity and manage the dynamics of difference? ○• How can you adapt to diversity and institutionalize culture knowledge?

Activity

Utilize your knowledge of the Cultural Proficiency Continuum to answer the follow- ing questions. Be prepared to discuss the following.

1. In Pairs, discuss and explain your understanding of the Continuum to each other.

2. Discuss where you are on the Continuum and give evidence and examples for your choice.

3. Discuss where you see Mrs. Collins and give evidence and examples for your choice.

4. Discuss where you see DHS and give evidence and examples for your choice. 5. Create a matrix of ideas as possible solutions to questions 3 and 4. 6. Develop an Equity School Improvement Plan (SIP) for DHS that responds to

the following prompt: What can DHS do to move from cultural blindness to cultural precompetence and beyond? Share it with your partner and seek feedback.

Equity SIP

Table 1. The Cultural Proficiency Continuum (Lindsey et al., 2018).

Goal Action items Person(s)

responsible Resources needed By when?

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Appendix A

The Conceptual Framework for Culturally Proficient Practices

Appendix B

Opportunity to Go Deeper

Because being a leader requires leaders to be chief learners, the following section offers recommended books on culture. Becoming culturally proficient is a life long

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journey but moving along the Cultural Proficiency Continuum is achievable by acquir- ing new knowledge, trying new practices, and reflecting.

Recommendations for Future Learning and Consideration

Talking about culturally responsive school leadership. Khalifa (2018) focuses on how all urban school leaders (from any race and ethnic background) can support minor- ity students. The author asserts that Culturally Responsive School Leadership (CRSL) must be a priority for urban school leaders to become effective instruc- tional leaders and have a positive impact on student learning regardless of the stu- dents’ cultural and racial origins and heritages. As a result, CRSL must be promoted by school leaders far and foremost. Khalifa also suggests that school leaders need to be or become critically self-reflective, support teachers to become culturally aware and responsive, help them develop culturally responsive curricula, provide inviting and safe learning environments, and lastly leaders need to engage everyone in the community.

Hofstede, Hofstede, and Minkov—6D. The Hofstede, Hofstede, and Minkov (2010) model is useful when working internationally. The model consists of consists of six cultural dimensions. The cultural dimensions represent independent preferences for one state of affairs over another that distinguish countries (rather than individuals) from each other. The model consists of the following dimensions:

Power distance index (PDI). This dimension expresses the degree to which the less powerful members of a society accept and expect that power is distributed unequally. The fundamental issue here is how a society handles inequalities among people. In societies with large degree of Power Distance, people accept hierarchy whereas in societies with low Power Distance, people strive to demand justification for inequities in power.

Individualism versus collectivism (IDV). Individualist societies refer to societies in which the propensity is for individuals to take care of themselves and their immediate family only. In Collectivistic cultures, people think of the needs of the group over indi- vidual needs. In such cultures, the relationships between people are valued and people define their self-image in terms of “we” versus “I.”

Masculinity versus femininity (MAS). In this dimension, the masculinity represents a preference in society for achievement, competitiveness, heroism, assertiveness, and material rewards for success. However, femininity embodies an inclination for cooperation, modesty, caring, and quality of life.

Uncertainty avoidance index (UAI). This dimension speaks to the degree to which individuals are uncomfortable with uncertainty. Countries exhibiting strong UAI are not tolerant of unconventional behaviors and ideas. Weak UAI societies have a more undisturbed attitude.

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Long-term orientation versus short-term normative orientation (LTO). Societies who score low on this dimension prefer to maintain time-honored traditions and norms. They do not like change. Those with a culture which scores high; however, they encourage efforts for change and as a way to prepare for the future.

Indulgence versus restraint (IND). Indulgence refers to a society that accepts having fun and enjoying life. Restraint is for a society that eliminates gratification of needs and controls it with strict social norms

Implicit bias. If you are alive, you have biases (DiAngelo, 2018). Implicit bias refers to the attitudes and stereotypes that dictate our actions and behaviors without our aware- ness (Banaji & Greenwald, 2016). Throughout our lifetime, we receive information that we store in our brain and the vast majority of it happens without us even realizing it. The difficulty with implicit biases is that they are located in our unconscious; hence, we do not know we have them until we identify them. Implicit biases form our blind spots and can impede the best of intentions. Today there are tools to identify implicit biases. Banaji and Greenwald (2016) have spent their career exploring implicit biases and have created the Implicit Association Test (IAT). The IAT has been taken by 14 million people worldwide (Banaji & Greenwald, 2016). Once one identifies his or her biases, it is possible to retrain the brain by:

○• Getting trained and educated on the impact of implicit biases. ○• Interacting with people from other races, cultures, ethnicities, age, socioeco-

nomic status, sexual identities, religions, genders, and abilities. ○• Practicing mindfulness (breathing before reacting, listening, reflecting, pro-

cessing situation before coming back to the situation). ○• Being able to show gratitude when someone points out that you react from a

place of prejudice, being able to apologize for the undesired reaction and to promise to yourself and the person that you are working on improving.

○• Observing the biases and stereotypes and replacing them by a counter example. For example, if you have a bias against small people, tell yourself that they are human being and as such deserves the respect and love.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Corinne Brion https://orcid.org/0000-0002-3234-8939

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Author Biography

Corinne Brion is an assistant professor at the University of Dayton. She earned her PhD in educational leadership at the University of San Diego. The overall framework for her research is equity. Her research interests include investigating the process of learning transfer among adult learners so to understand what enhances and hinders the transfer of knowledge in different contexts. She is also interested in girls’ education and in the role technology plays in improving education. She has presented her research at Comparative and International Education Society conference (CIES), University Council for Educational Administration (UCEA), and United Nations Educational, Scientific and Cultural Organization (UNESCO). Her work has also appeared in the Journal of Educational Leadership and Policy Studies, Educational Research for Policy and Practice, and Frontiers in Education.

Federal Nursing Home Reform Act from the

Omnibus Budget Reconciliation Act of 1987 or simply

OBRA ‘87 SUMMARY

Developed by Hollis Turnham, Esquire In 1987, President Ronald Reagan signed into law the first major revision of the federal standards for nursing home care since the 1965 creation of both Medicare and Medicaid 42 U.S.C1396r, 42 U.S.C. 1395i-3, 42 CFR 483. The landmark legislation changed forever society’s legal expectations of nursing homes and their care. Long term care facilities wanting Medicare or Medicaid funding are to provide services so that each resident can “attain and maintain her highest practicable physical, mental, and psycho- social well-being.” Medicaid Provision: 42 U.S.C. 1396r(b)(4) http://www4.law.cornell.edu/uscode/42/1396r.html Medicare Provision: 42 U.S.C. 1395i-3(b)(4) http://www4.law.cornell.edu/uscode/42/1395i-3.html Federal Regulations: 42 CFR 483.25 http://www.access.gpo.gov/nara/cfr/cfr- retrieve.html - page1 (Use the search engine at the bottom of the page to retrieve a specific title part and section.) WHAT IS OBRA '87? The Federal Nursing Home Reform Act or OBRA ‘87 creates a set of national minimum set of standards of care and rights for people living in certified nursing facilities. This landmark federal legislation comes by its common name “OBRA” through the legislative process. Congress, then and now, usually completes a huge measure of its budgetary and substantive work in one large bill. The bill accomplishing that function in 1987 was entitled the Omnibus Budget Reconciliation Act of 1987 or “OBRA ‘87.” The separate Federal Nursing Home Reform Act along with many other separate bills was “rolled into” one bill to insure final passage of all the elements. These minimum federal health and care requirements for nursing homes are to be delivered through variety of established protocols within nursing homes and regulatory agencies. And as minimum standards, Long-Term Care Ombudsmen should view OBRA as a baseline that should be built upon to reach not only resident “well-being” but also happiness and fulfillment. OBRA also recognized the unique and important role performed by the LTCOP for nursing home residents. The federal Medicaid and Medicaid legislation included those

distinct advocacy roles and subsequent regulations and other guidance has given LTCOPs additional tools to serve resident interests. The changes OBRA brought to nursing home care are enormous. Some of the most important resident provisions include:

• Emphasis on a resident’s quality of life as well as the quality of care; • New expectations that each resident’s ability to walk, bathe, and perform other

activities of daily living will be maintained or improved absent medical reasons; • A resident assessment process leading to development of an individualized care

plan 75 hours of training and testing of paraprofessional staff; • Rights to remain in the nursing home absent non-payment, dangerous resident

behaviors, or significant changes in a resident’s medical condition; • New opportunities for potential and current residents with mental retardation or

mental illnesses for services inside and outside a nursing home; • A right to safely maintain or bank personal funds with the nursing home; Rights

to return to the nursing home after a hospital stay or an overnight visit with family and friends The right to choose a personal physician and to access medical records;

• The right to organize and participate in a resident or family council; • The right to be free of unnecessary and inappropriate physical and chemical

restraints; • Uniform certification standards for Medicare and Medicaid homes; • Prohibitions on turning to family members to pay for Medicare and Medicaid

services; and • New remedies to be applied to certified nursing homes that fail to meet minimum

federal standards. OBRA set in motion forces that changed the way state inspectors approached all their visits to nursing homes. Inspectors no longer spend their time exclusively with staff or with facility records. Conversations with residents and families are a prime time survey event. Observing dining and medications administration are a focal point of every annual inspection. Under OBRA, Long Term Care Ombudsman Programs have defined roles to fulfill and tools to use in the annual inspection process to nurture the conversations between residents/families and inspectors and life in the nursing home. HOW DID OBRA '87 COME ABOUT? The federal Nursing Home Reform Act became law with growing public concern with the poor quality of care in too many nursing homes and the concerted advocacy of advocates, consumers, provider associations, and health care professionals. Congress asked the Institute of Medicine (IoM) to study how to better regulate the quality of care in the nation’s Medicaid and Medicare certified nursing homes.

In its 1986 report Improving the Quality of Care in Nursing Homes, the expert panel recommended:

• A stronger federal role in improving quality; • Revisions in performance standards, the inspection process, and the remedies to

improve nursing home services; • Better training of nursing home staff; • Improved assessment of resident needs; and • A dynamic and evolutionary regulatory process.

Information can be found at: http://www.nao.edu/books/0309026461 In order to assure implementation of the IoM recommendations from the “blue ribbon panel,” the National Citizens' Coalition for Nursing Home Reform organized the “Campaign for Quality Care” to support the federal reforms. National organizations representing consumers, nursing homes, and health care professionals worked together, and continue to work, to create consensus positions on major nursing home issues. Their consensus positions on the IoM report laid the foundation for the federal law. OBRA has changed the care and lives of nursing home residents across America. There have been significant improvements in the comprehensiveness of care planning. Anti- psychotic drug use declined by 28-36% and physical restraint use was reduced by approximately 40%. Several states have taken all or parts of OBRA ‘87 and made them state law for their licensed nursing homes or other kinds of long term care facilities. For example, the state of Washington has extended the rights that nursing home residents have to residents of all Washington long term care facilities. RCW 70.129.005 And, Michigan has incorporated many of the OBRA prohibitions on Medicaid discrimination into state law. MCLA 333.21765a. Online Research: The links to federal laws and regulations in this document have been made to the most reliable sources known to the Ombudsman Resource Center. Links to the Medicaid and Medicare laws are made to the Legal Information Institute maintained by Cornell University. The federal code of regulations is accessed here through the United States Government Printing Office. If these resources do not meet your needs or you find better resources for federal legal research, please contact Center staff at [email protected]