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
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!"
Retrieved from http://www.arc.gov/appalachian_region/
Retrieved from http://www.cdc.gov/pcd/issues/2010/
Issue 7 * 2016 * DIGITAL
CHARACTERISTICS OF APPALACHIANS
Strong family ties
Believe in God
Content with where they live
Strong community ties
Very close to nature
* Take care of others
* Strong sense of what is right and what
* 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
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.
BARRIERS TO HEALTHY LIVING IN APPALACHIA
* Limited access to clinics, hospitals, and specialists
* Cost of health care
* Lack of faith/distrust in modern medicine
* 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
* Dependence on family
* Travel distance to wellness centers
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?
Table of Contents for the Digital Edition of CMSA Today - Issue 7, 2016
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