CMSA Today - Issue 7, 2016 - 22

levels, fear, lack of facts about healthcare and distrust of the medical system. Appalachians consider both their faith and the possible benefits of obtaining healthcare when seeking solutions to health problems. Traditionally, they do not seek attention and try to manage their own problems. First they turn to family for assistance, then the local church. Being self-reliant is very important. They are characterized as proud, private, taking care of their own and not accepting of charity. Personal trust is hard to gain, but, once gained it is hard to lose. Trust is a critical factor in their acceptance of health-related information and use of healthcare services. Generally, Appalachians are content when their basic needs are met for shelter, food and transportation. UNDERSTANDING THE CULTURE Working with people of Appalachian culture requires multicultural expertise, just as working with other minorities. The first step is to understand the culture. Appalachians expect others to respect their freedom, independence and self-sufficiency. Poverty is a reality. There are regional differences within the culture, and many modern-day Appalachians try to distance themselves from the stereotypes of the culture. However, Appalachians have now become somewhat homogenized with other regions. This is primarily related to watching the same television shows, reading the same magazines and books, and shopping at branches of the same retail stores. Although many television programs and films have portrayed the Appalachian culture in a negative way, this culture has remained stoic, proud, and independent. ■ Janet S. Coulter, MSN, MS, RN, CCM, currently serves on the CMSA National Board as a Director and Member at Large. She is past president of Southern Ohio Valley CMSA. She has over 40 years of nursing experience and 11 years of experience in workers compensation case management. Janet has worked in managed care, acute hospital and education settings. She is currently Chair, Breckinridge School of Nursing and Health Sciences. Janet was born, raised, and educated in Appalachia, and she considers herself a "Mountaineer!" REFERENCES * Retrieved from http://www.arc.gov/appalachian_region/ * Retrieved from http://www.cdc.gov/pcd/issues/2010/ MapofAppalachia.asp Sep/09_0203.htm 22 CMSA TODAY Issue 7 * 2016 * DIGITAL TABLE 1 CHARACTERISTICS OF APPALACHIANS * * * * * * * * * * Very independent Strong family ties Believe in God Self-sufficient Hardworking Content with where they live Strong community ties Very close to nature Friendly Kind * Helpful * Take care of others * Strong sense of what is right and what should be * Deep mistrust of anyone new or strangers * Resist change * Slow to accept outsiders * Reluctant to accept authority * Closely guard family secrets/business * Strong sense of purpose TABLE 2 SUGGESTIONS FOR EFFECTIVE CASE MANAGEMENT INTERVENTIONS * * * * * * * * * * * * * * * * * * Be familiar with your own culture and values. Become familiar with Appalachian culture. Be on time and reliable. Active listening is very important. Allow the client to tell his or her story. Try to see client's perspective. Start with pleasantries/small talk during the first meeting. Ask for an explanation if you do not understand terms. Don't be the "expert." Avoid giving "orders." Strive to establish trust and rapport. Avoid confrontation whenever possible. Gently return client to goal or topic when avoiding. Avoid technical jargon. Show respect: clients who do not feel respected will not return. Include family, community, and church whenever possible. Explore spirituality/religious beliefs if indicated. If substance abuse is an issue, explore client's perception as illness and/or sin. TABLE 3 BARRIERS TO HEALTHY LIVING IN APPALACHIA * Limited access to clinics, hospitals, and specialists * Cost of health care * Lack of faith/distrust in modern medicine * Rural * Rugged terrain/limited areas to walk * Use of folk medicine, herbs and homemade remedies * Pride may prevent them from seeking/accepting help from others * Distrust of outsiders and outside organizations * Limited access to quality foods * Poverty * Dependence on family * Travel distance to wellness centers * Superstitions TABLE 4 DID YOU KNOW... * Did you know the government declared a "war on poverty" in Appalachia many years ago? * Did you know that the people of Appalachia have some of the worse health issues in this country? * Did you know that they have very high morbidity from chronic illnesses such as heart disease, hypertension, depression and drug addiction? * Did you know that they have one of the highest rates of diabetes and obesity in the nation? http://www.arc.gov/appalachian_region/mapofappalachia.asp http://www.cdc.gov/pcd/issues/2010/sep/09_0203.htm

Table of Contents for the Digital Edition of CMSA Today - Issue 7, 2016

PRESIDENT’S LETTER
ASSOCIATION NEWS
CMSA CORPORATE PARTNERS
Are You Culturally Competent?
Return to Culture – Return to Healing
Appalachian Culture: A Guide for Case Managers
Professional Case Management’s Ethical Quartet for 2017: Part 1, Workplace Bullying and End of Life Care
Diversity of Role Reversal: When the Case Manager Becomes the Patient
INDEX OF ADVERTISERS
CMSA Today - Issue 7, 2016 - cover1
CMSA Today - Issue 7, 2016 - cover2
CMSA Today - Issue 7, 2016 - 3
CMSA Today - Issue 7, 2016 - 4
CMSA Today - Issue 7, 2016 - 5
CMSA Today - Issue 7, 2016 - PRESIDENT’S LETTER
CMSA Today - Issue 7, 2016 - 7
CMSA Today - Issue 7, 2016 - 8
CMSA Today - Issue 7, 2016 - 9
CMSA Today - Issue 7, 2016 - ASSOCIATION NEWS
CMSA Today - Issue 7, 2016 - 11
CMSA Today - Issue 7, 2016 - CMSA CORPORATE PARTNERS
CMSA Today - Issue 7, 2016 - 13
CMSA Today - Issue 7, 2016 - Are You Culturally Competent?
CMSA Today - Issue 7, 2016 - 15
CMSA Today - Issue 7, 2016 - Return to Culture – Return to Healing
CMSA Today - Issue 7, 2016 - 17
CMSA Today - Issue 7, 2016 - 18
CMSA Today - Issue 7, 2016 - 19
CMSA Today - Issue 7, 2016 - Appalachian Culture: A Guide for Case Managers
CMSA Today - Issue 7, 2016 - 21
CMSA Today - Issue 7, 2016 - 22
CMSA Today - Issue 7, 2016 - Professional Case Management’s Ethical Quartet for 2017: Part 1, Workplace Bullying and End of Life Care
CMSA Today - Issue 7, 2016 - 24
CMSA Today - Issue 7, 2016 - 25
CMSA Today - Issue 7, 2016 - 26
CMSA Today - Issue 7, 2016 - 27
CMSA Today - Issue 7, 2016 - Diversity of Role Reversal: When the Case Manager Becomes the Patient
CMSA Today - Issue 7, 2016 - 29
CMSA Today - Issue 7, 2016 - 30
CMSA Today - Issue 7, 2016 - 31
CMSA Today - Issue 7, 2016 - 32
CMSA Today - Issue 7, 2016 - 33
CMSA Today - Issue 7, 2016 - INDEX OF ADVERTISERS
CMSA Today - Issue 7, 2016 - cover3
CMSA Today - Issue 7, 2016 - cover4
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