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Review the module readings. Select a minority group and create a handout with images and key points on the cultural and ethnic aspects that need to be considered in working with and creating case management interventions for this population. Provide references to support your statements.
Evaluators of human service programs can be any professionals in the human service field, including case managers. However, even if a case manager never conducts an evaluation, it is very important for case managers, and indeed all human service professionals, to be aware of evaluation processes and procedures. Additionally, case managers should do their best to implement effective and valid procedures in their program to ensure that their program or service meets the appropriate ethical codes. These elements are even more important when human service programs are serving minority populations, especially those with limited English language proficiency, low literacy levels, low socioeconomic levels, and even questionable immigrant status. Case managers should understand program evaluations and the questions surrounding a program evaluation. Some questions include: How do case managers and other human service professionals determine if a program or service is effective? Why is evaluation important? Who does evaluation? How do human service professionals ensure that evaluations take into account minority and underserved populations? What ethical considerations must be taken into account in programs and in evaluating programs or interventions?
Program evaluation consists of several factors including methods to determine whether a program or service is warranted and is likely to be used. Evaluations should review whether the program is appropriately meeting needs and whether the program or service is conducted as planned. Finally, evaluators should consider whether or not the service or program does help clients and if the program or services are economically viable (Loi & McDermott, 2010). Language, cultural beliefs, socioeconomic barriers, deference to authority figures, and other factors need to be considered when evaluating programs (Loi & McDermott, 2010). In order to do this, evaluators need to have appropriate training, education, and experience with minority populations. Evaluators are also responsible for ensuring that the highest ethical standards are being applied during the evaluation process. “Conducting evaluations that are both valid and ethical are imperative for the support and sustainability of programs that address underserved and vulnerable populations” (Loi & McDermott, 2010, p. 252).
It is important that an evaluator gain the trust of whomever they are evaluating. Why is this important? If trust is not established, then the validity and reliability of the evaluation process is at risk and the results cannot be trusted. One method to assist with garnering trust from minority populations is engaging a gatekeeper in the process. The gatekeeper is someone who has social and cultural standing in the minority population’s community. This gatekeeper can help with translating and ensuring that the vulnerable population’s needs and concerns are addressed in a culturally sensitive manner (Loi & McDermott, 2010).
Ethical Considerations in Evaluation
Along with establishment of a gatekeeper, what are some of the other ethical considerations in evaluating programs that serve vulnerable populations? Important ethical codes evaluated as part of a program or service can include the comprehension of informed consent and payment is not coerced. This is especially true with clients who have low levels of literacy, are poor, and belong to ethnic minority groups. Informed consent can be a very tricky process. People who do not speak English as their first language may have great difficulty comprehending the informed consent process (Loi & McDermott, 2010). Even if the consent form is translated into the minority population’s language, the translation may not be as clear as it needs to be, and consent forms can sometimes be written with complex legal language so that even translating the document may not help the client understand what they are consenting to (Loi & McDermott, 2010). Evaluators can better ensure valid informed consent by using other means to obtain it, such as, but not limited to, pilot testing, a seven-step translation process, and the use of tools from national bodies (Loi & McDermott, 2010).
Confidentiality is another important ethical aspect that evaluators need to be concerned about. Informed consent sometimes requires phone numbers or social security numbers; if this information somehow gets leaked to the wrong person or body, the clients can be in jeopardy. The reassurance may not assuage a minority person’s concerns, no matter how much an evaluator or service provider ensures that great pains are taken to protect confidentiality. This can be especially true with immigrants who may or may not have appropriate documentation (Loi & McDermott, 2010). It is also important to note that the burden to the clients or recipients of services must be considered. One method to address this burden is to collect data after hours or on weekends in locations more convenient to the recipients. It is important to understand that flexibility helps ensure valid evaluation.
Finally, when writing their evaluations, an evaluator should also factor in other perhaps more subtle or indirect support the program or service is providing. A program or service may have an important impact on its clients not evident when evaluating just the program or service’s outcomes. The program or service could be the only entity providing a social support system not directly aligned with a program’s goals or mission statement, for example (Loi & McDermott, 2010).
Culturally Responsive Best Practices: How to Decide?
Best practices and evidence-based interventions should be evident in all programs and services. Take, for instance, the best practice of being culturally responsive. The following example illustrates how a case manager could inappropriately implement a culturally responsive best practice. For example, a case manager is attempting to serve a minority group population with a best practice based on a majority group. The case manager is not providing appropriate cultural responsiveness for the minority population because of the inappropriate application of a best practice. The best practice in this case would be to find a minority best practice and apply it to the minority group population. However, sometimes it can also be challenging to obtain enough members of a minority group for a sound and valid study evaluating a practice in hopes of establishing a best practice. It is also important to note that many minority groups have both heterogeneous and homogenous components (some are more assimilated and acculturated than others, even within the groups). A minority group’s participation in a study for a particular practice will not necessarily guarantee that the outcomes obtained will apply to everyone who identifies as being part of that minority group.
Case managers need to do their best to conduct a literature review of available best practices, decide if the best practices they want to integrate into their work have adequately addressed the minority population’s cultural needs and concerns, and make any appropriate modifications that may be warranted (based on other research or evidence). “The process of EBP [evidence-based practice] begins with systematic reviews of randomized . . . trials. When randomized . . . trials are not available, less strong evidence from descriptive and qualitative studies can be considered for . . . decisions [about which EBP to incorporate or utilize in a program]” (Hulme, 2010, p. 273). Sometimes a rigorous, evidence-based practice for a specific population may not be found; case managers and human service professionals will have to make a decision whether or not to implement the “next best” practice, and potentially with modifications, as well. Ideally, an evaluation of this “next best” practice can be undertaken to ascertain whether or not the best practice is relevant and meets the needs of the population being served.
Case managers utilize a hierarchy when selecting which best practice to incorporate into culturally responsive interventions, in descending order of importance:
Select the practice that is based on rigorous research that also includes the population being served
Select the practice that is based on rigorous research that may not include the population being served, but could be modified
Select the practice that includes the population being served, but perhaps was not the most rigorous research available
Select the practice that has preliminary evidence to support being used with the population being served (for example, only one or two studies have been conducted to evaluate the practice)
Select a practice that has little to no evidence, but will be evaluated by research with the population being served (for example, an agency selects a practice along with funding to study the outcomes.
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