Running head: CULTURAL IMMERSION

Cultural Immersion Experience & Agency Assessment Report

Devon Vitti

Wilmington University
Cultural Immersion Experience & Agency Assessment Report 2

Cultural Immersion Experience

Cultural competence is an important pillar of being a successful human service

professional. The National Organization of Human Services outlines in its Ethical Standards for

Human Services Professionals (2015) in standard 26 the importance of human service

professional to “seek the training, experience, education and supervision necessary to ensure

their effectiveness in working with culturally diverse individuals based on age, ethnicity, culture,

race, ability, gender, language preference, religion, sexual orientation, socioeconomic status,

nationality, or other historically oppressive groups. In addition, they will strive to increase their

competence in methods which are known to be the best fit for the population(s) with whom they

work.” This really highlights the importance of being cultural competent in the field of human

services.

Cultural Immersion Experience

Currently, I work at Union Hospital of Cecil County located in Elkton, Maryland. I also

chose this site to do my capstone project with a focus on developing an integrated collaborative

care model of behavioral health into our existing primary care practice. Union Hospital of Cecil

County is a 122-bed non-profit community hospital located in Elkton, Maryland that provides

inpatient, outpatient, and emergency services to residents of Cecil County and surrounding areas.

The mission of Union Hospital of Cecil County is to provide safe, high quality health services to

residents of Cecil County and neighboring communities.

Populations Served

Union Hospital of Cecil County is the only hospital system located in Cecil County,

Maryland and it serves the entire population. Cecil County, as a whole, is a rural county with a
Cultural Immersion Experience & Agency Assessment Report 3

total population of 102,922 persons (UHCC, 2018). In terms of population by race in Cecil

County, the population make up is: White 86.98 %; Black/African American 7.21%; American

Indian/Alaskan Native 0.36%; Asian 1.33%; Native Hawaiin/Pacific Islander 0.05%; Some

Other Race 1.37%; and 2+ Races 2.70%. In terms of ethnicity, 4.72% of the population

identifies at Hispanic/Latino and remaining 95.28% is Non-Hispanic/Latino. In terms of

population by age group: 22.28% of the population is 0-17 years old; 8.19% is 18-24 years old;

53.19% of the population is 25-64 years old; and remaining 15.61% is 65+ years old. In terms of

gender, the population is almost evenly split: 49.61% males and 50.39% females. In terms of

languages spoken at home: 95.05% speak only English; 2.08% speak Spanish; 1.98% speak

Indo-European; and 0.89% speak another language (UHCC, 2018).The median income for Cecil

County as a whole is $75,027, however, there is fluctuation by race/ethnicity with Whites and

Pacific Islanders earning more than African Americans, Asians, and Hispanics (UHCC, 2018).

Additionally, 6.66% of families in Cecil County live below the poverty line. Lastly, in terms of

employed adults by occupational group, 59.51% work in a white collar occupation; 23.34% work

in a blue collar occupation; and 17.15% work in service and farm occupation.

In terms of a population to focus on, I will focus on children, as the hospital as a whole

has limited pediatric services and only provides emergency care in the emergency department

and limited postpartum care for newborns born in the hospital. Additionally, behavioral health

services are only focused on adults and does not address mental health needs of children or

parents with children who have mental health needs.

Population History

American Indians were the early settlers of Cecil County until white men from Europe,

led by Captain John Smith arrived in 1608 (Cecil County, 2018). In the coming years, colonists
Cultural Immersion Experience & Agency Assessment Report 4

would soon settle in the area and eventually Lord Baltimore would lay claim to the land. Cecil

County became and somewhat still remains a large agricultural and farming industry. Its nearby

proximity to the rivers also led to a fishing and trade industry. This explains a large majority of

the current population and demographic for this region. Additionally, Union Hospital of Cecil

County was built in 1908 due to the need for a hospital for the region and continues to serve the

same region(Cecil County, 2018).

With 22% of the population, or 22,000+ children, being under the age 18 this is an

important population to focus on. Often mental health problems for children are overlooked or

not understood by parents and can make parenting difficult. Gwendolyn Cremers..et al (2014)

discusses that parents of children with mental health issues in rural areas struggle with common

themes of: “ Being observed and negatively judged by others; Overshadowed by the duality of parenting

and mental health problems; Dominance of medication over other treatment options; Uncertainty (of

impact on parenting ability and children) and Need for Inclusion’’. This demonstrates the importance of

addressing children mental health needs and supporting the parents of the children.

Immersion Activity – Film

I chose the film Wonder for my cultural immersion activity. Wonder is about a young boy,

August “Auggie” Pullman who was born with a rare facial deformity. He has had many surgeries to help

correct some of this and as a result he has been homeschool by his mother much of his life. His parents

decide to enroll him in school in fifth grade and decide for him to go to a private school. During this

process he has to deal with his depression and anxiety about going to school for the first time. As he

attends school he is ridiculed and bullied early on. His parents are often distraught on how to handle this

and conflicted throughout the film. Eventually, Auggie is accepted by his classmates and is later
Cultural Immersion Experience & Agency Assessment Report 5

recognized as a standing out among his classmates for which he receives a standing ovation at the end

(Chbosky, Wonder).

I chose this movie for a few reasons, mainly, because I believed it to the opposite of what would

happen if this took place in a rural area with an average family. Despite his physical and mental health

challenges, Auggie had an extremely supportive mother and father; his mother stop working and going to

college to take care of and homeschool him; his father is successful in his career and is able to afford their

home in Upper Manhattan, New York and support their family financially; Auggie goes to a private prep

school as opposed to a public school; and he has full support of the school administration (Chbosky,

Wonder). I think when looking at the median income for Cecil County, especially those minorities who

earn less than that, they would not have the same opportunities and chances as someone like Auggie.

They would likely go to public school and may not have the same level of attention and detail that he had

or the parent may need to work and may not be able to homeschool their child.

Immersion Activity – Self Help Group

For an in-person immersion experience, I chose to attend the Kids Can Cope support group at

Union Hospital. The group is run the oncology department personnel, usually their social worker or a

nurse facilitates, and is a support group aimed at children ages 6-13 who have a parent or loved with

cancer or another form of a chronic illness. Activities are focused on how to cope and identify feelings,

as well as, learn from one another via mutual support. This group was different for me, I have facilitated

adult mental health groups but children are a different audience to work with. The group facilitator

started with an ice breaker activity to get everyone warmed up with one another and then had a group

activity focused on creating a “coat of arms”, in which they drew a shield portraying their family

symbols/values and what made them strong. Each child was able to present their coat of arms picture to

the group. The children had various colors, symbols and pictures demonstrated what their family meant

to them. It was amazing to see the resilience in these children, as many of them discussed what life was
Cultural Immersion Experience & Agency Assessment Report 6

like for them dealing with a sick or ill family member. Overall, this experience reminded me of the

importance of children’s mental health and that if we do not support and help them when they are

younger, they will have life-long challenges.

Agency Assessment

For the agency assessment, I will be focusing on Union Hospital of Cecil County. Working at

Union Hospital has offered me a cultural experience I have never had anywhere I worked before. As a

small community hospital, many local residents live and work at the hospital. The staff members are all

very warm and welcoming from the housekeeping department to the Chief Executive Officer (who prefers

you call him Rich and not Dr. Szumel). You are guaranteed to get a hello or a smile no matter where you

are in the organization. Considering the demographic make-up of the County, the hospital itself is very

diverse and inclusive. The hospital itself is located in Elkton, Maryland, which is the largest city in Cecil

County and it is near many social services agencies, the local health department, retail and social centers.

Regarding the selected population, there are schools that serve children and that have services within the

schools, social service agencies that serve and protect children, and community mental health agencies

that provide services to children.

Access to transportation is a problem in Cecil County due to the rural nature of the county and

limited transportation options. The only public transportation available is the bus services that are limited

to the main Route 40 corridor in the county. For those residents in more remote areas, it could be very

difficult for them to get to a bus stop. If one does not have a car, they also would be limited. In terms of

a hospital and inpatient or outpatient services, it would be important for a patient to be present for their

appointments. Obviously, in an emergency, first responders could transport a patient to the hospital.

Unfortunately, in terms of our population, once a child is stabilized in the emergency department, they

would need to be transferred out to another hospital if they needed additional services. This could be as

far as the neighboring state of Delaware or being sent to a hospital in Baltimore, Maryland. This could
Cultural Immersion Experience & Agency Assessment Report 7

prove to very challenging for a parent or family to be with their child. For a human service professional

within the hospital, it is important for them to be aware of the potential needs of their clients, as

mentioned in standard 15 of NOHS (2015).

As mentioned earlier, there is a great emphasis within the organization on receptivity and treating

all clients and citizens equal as mentioned in standard 10 of NOHS (2015). The hospital and outpatient

practices are very clean and modern in terms of their furnishing and décor. I have been a patient in the

emergency department, urgent care, diagnostics areas, and in the physician practices and have felt that I

have had a good experience in all the settings. The hospital has paper and electronic information

displayed appropriately and offers translation services.

In terms of training, staff is provided with cultural competence training as part of their orientation

process and has yearly competencies related to cultural competence. All staff is expected to complete

these trainings. Trainings have also been added as needed to address certain problems and issues that

have arisen. For example, there were recent concerns and mandates to address suicide risk in patients and

trainings and policies were developed to address this. This is important in terms of standard 11 and 13 of

NOHS (2015) and being aware of social issues/multiculturalism. The hospital also employs individuals

of all backgrounds.

In terms of funding, much of the funding is generated through fees for services rendered and are

reimbursed by the patient’s insurance and the patient themselves. The hospital will at times receive grant

dollars to address certain initiatives or projects. Additionally, the hospital will also fundraise for specific

populations or areas. For example, the hospital recently fundraise for its cancer support program for

patients, in which the money raised will go to helping patients with cancer on their needs. The hospital

also provides charity care and will waive payments or reduce payments for those experiencing financial

hardship. Funding is also budgeted appropriately to allow for trainings and conferences for staff to learn

and teach other staff.

Cultural Immersion Experience & Agency Assessment Report 8

Staff sensitivity is very important in the healthcare field and great strides have been taken within

the hospital to promote a safe and high reliability culture within the organization. Healthcare staff needs

to be unbiased and nonjudgmental when working with the variety of patients that they do treat. Staff are

very respectful to all populations served and have been trained in how to deal with difficult situations that

may arise and how to deliver service recovery in real-time. If staff sensitivity does not exist, this can be a

real problem for an organization and will likely bring harm and risk to the organization. As standard 10

of NOHS (2015) points out human service professional must provide services without discrimination or

preference in regards to any demographic or oppressed group they treat.

Overall, the hospital has made efforts to address the needs of children. Recently, the hospital

partnered with A.I. Dupont Hospital for Children to provide coverage and services on a pediatric unit and

for children born on the maternity unit. The hospital partners with other community and social service

agencies to address the needs of this population. Currently, the hospital is going through a potential

merger with another healthcare system and this may bring about additional change for the hospital and

services and needs will be reviewed and expanded upon. The needs of the pediatric population will need

to be addressed during these high-level talks and the planning that is scheduled to take place. The

hospital is committed to quality and has several varying layers of quality control from a quality

department to the quality committee of the Board of Directors. There are some unmet needs with this

population, especially for inpatient and outpatient mental health services. The state of Maryland has

limited resources for children and often relies on community agencies and services to serve this

population.

Conclusion

Overall this cultural immersion exercise was a good experience and is something I may use in the

future at training my staff to be more culturally competent. As we had discussed, cultural competence
Cultural Immersion Experience & Agency Assessment Report 9

and being culturally sensitive is vital to a human service agency and professional in being successful with

their target population.

References

Cecil County Health Data. (n.d.). Retrieved from https://www.uhcc.com/about-us/community-

benefit/cecil-county-health-data/
Cecil County History. (n.d.). Retrieved from
http://www.ccgov.org/government/tourism/explore/history
Chbosky, S. (Director). (2017). Wonder [Motion picture on DVD]. United States: Lionsgate.
Cremers, G. E., Cogan, N. A., & Twamley, I. (2014). Mental health and parenting in rural areas:
an exploration of parental experiences and current needs:[*]. Journal of Mental Health, 23(2),
99–104. https://doi-org.mylibrary.wilmu.edu/10.3109/09638237.2014.889283
NOHS. (2015). Ethical Standards for Human Services Professionals. Retrieved from
https://www.nationalhumanservices.org/ethical-standards-for-hs-professionals
Ronnau, J. (2001). Values and Ethics for Family-Centered Practice. In E. Walton, P. Sandau-
Becker, & M. Mannes (Eds.), Balancing family-centered services and child well-being. (pp. 34-
54). New York,NY: Columbia University Press.