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Cultural Competency Back to Course Index

 

 

 

 

Introduction

Although this country has come so very far, we still have lessons to learn and wounds to heal.  Over the last year, you can’t turn on a news program or look on social media without being confronted on a social issue regarding racism, prejudice, relational lack of awareness, gender, religious differences, and fear regarding differences of opinion.  Now more than ever, it is crucial for mental health professionals to make every attempt to understand each person’s unique experience and to try to see them and their situation through their eyes and not our own.  We have to be ever aware of what our experiences and worldview bring into the counseling relationship. 

I cannot hear a client through the noise of my own reality if I don’t learn how to set aside my understanding and see the world from their perspective.

This is a challenging subject to educate on because by virtue of saying, “we need to….”, or “it is important to…” I am stepping into a role of assuming I know what other cultures, races, religions, and genders need.  As I only represent mine and can only try to learn about others, the best I can do is share the academic information and hope it is beneficial. 

 

Mass racial violence in the United States can include such disparate events as:

  • The racially-based communal conflict against African Americans that took place before the American Civil War, often in relation to attempted slave revolts, and after the war, in relation to tensions under Reconstruction and later efforts to suppress black voting and institute, Jim Crow
  • The conflict between Americans and recent European immigrants in the 19th and 20th centuries
  • Between Asian Americans and White Americans during and after the Gold Rush, culminating in the Chinese massacre of 1871 and the Rock Springs massacre.
  • Attacks on Native Americans and Americans over the land
  • Frequent fighting among various ethnic groups in major cities, specifically in the Northeast and Midwest United States throughout the late 19th century and early 20th century, as fictionalized in the 1957 stage musical West Side Story and its 1961 film adaptation, depicting ethnic conflict in New York between Puerto Ricans and Italians.
  • Anti-immigrant violence targeted at Latin Americans in the 20th century
  • Two concurrent but distinct patterns of disturbances in the civil rights era: racial disturbances resulting from demonstrations and protests, as at the Marquette Park Illinois march of August 1966 or at the 1969 Greensboro uprising in North Carolina, as opposed to the Ghetto riots in the United States (1964–1969), a grouping that includes the Long, hot summer of 1967 and the King assassination riots of 1968, which caused mass violence, looting, and long-lasting damage within African-American communities.
  • Protests and riots answer allegations of police brutality in Rodney King, George Floyd, and Breonna Taylor.

 

Historical documents often refer to the United States as the great cultural experiment or a melting pot as diverse peoples are molded and shaped into the American Way of Life.  This undertaking has yielded various shades of success as new citizens adapt to a common language, habits, and values.  The outcome of the great culture experiment will be determined over the next several generations.  A common view is that we, the people, have made a lot of progress toward accepting people based on their individual merits, but we have a long way to go to overcome all of the cultural barriers.   The trend toward cultural pluralism continues to be embraced to promote various cultural groups’ co-existence, who may simultaneously maintain some of their distinctive characteristics.  However, there are other conflicts between ethnic and cultural groups, and there is inequality in the social and economic resources available to different groups.  There are also different general acceptances, power, and prestige issues between ethnic and cultural groups and differences with the majority cultures.   These have a significant impact on minority persons who may also have a social or community need.  It is often difficult to separate socioeconomic, ethnic, gender, age, and other variables that influence the behavior and attitude of members of these sub-populations.   Consequently, they often experience multiple jeopardizes, including minority statutes, parenting problems, physical and mental challenges, age, lifestyles, and other factors.

Individuals who are disadvantaged and sometimes disenfranchised are sometimes labeled as hidden populations and include homeless, chronically mentally ill, criminal and juvenile offenders, prostitutes, runaways, and others.  It follows that less personal and research data are available on these groups due to their migratory lifestyles and loss of identity.  They are generally omitted from surveys because they are not living in typical homes, are not attending school, and choose not to cooperate with interviewers.   However, many members of these groups have a greater need for social services, medical, food, shelter, and other services than the general population.

The United States remains a nation in which ethnic minorities and other disadvantaged groups (elderly, females, etc.) are often subjected to prejudicial treatment and continuously deal with negative life experiences, including language, religion, family relationships, value system, and community norms.  Minority groups and other special subpopulations are disproportionately represented among the economically disadvantaged.  They are more likely to live in urban centers with higher crime rates, poorer schools, substandard housing, and fewer employment opportunities.  

imgres-1 Ethnic populations are set apart from the mainstream culture by differences in language (whether a foreign language or an English dialect) and create communication difficulties.  The language barrier (includes reading, writing, and verbalizing) increases stress, interferes with psychosocial functioning, and increases the difficulty associated with getting the help they need to successfully integrate themselves into society’s mainstream.   Consequently, additional services are often needed to overcome previous deficiencies and accelerate the interventions needed for complex social problems.

It should be noted that many ethnic group members, and other special populations, often demonstrate remarkable strengths despite many obstacles and hardships.  In some cases, powerful religious beliefs help sustain members through difficult situations.  Although family relationships and values may be different, supportive bonds may be formed through extended family members (may include non-related individuals) that are not typically found in the mainstream culture.

 

 

The Melting Pot   images-9

The Statue of Liberty symbolizes the freedom that greeted Europeans that enter the US at Ellis Island.  The Golden Gate Bridge served the same purpose for Chinese and other Asians who arrived in San Francisco.   The number of Asian immigrants arriving in the US during the 19th Century was significantly lower than immigrants from other parts of the world.  However, thousands did migrate due to political oppression and to take advantage of the economic opportunities that existed in the US.   The following are some of the major immigration movements to the US:

 

Japanese: Over 25,000 Japanese (the vast majority were farmers and farm laborers) immigrated to Hawaii during the late 1800s due to large-scale unemployment, bankruptcies, and other civil discord in their homeland.   Also, a concurrent boom in the Hawaiian sugar industry created a need for additional farm workers.  Most Japanese immigrants choose to remain in Hawaii because race relations were better than in the mainland US. Initially, the Japanese gained acceptance into society by working as agricultural laborers for lower wages.  The natural process of acculturation was interrupted on December 9, 1941, when the Japanese attacked Pearl Harbor. 

Post World War II, Japanese immigration is a different story.  The so-called second generation of Japanese Americans has gained acceptance in all professions at an accelerated rate.   With increased education (or a higher focus on education), the Japanese sought lucrative professions. Consequently, by the 1990s, the Japanese had surpassed the national average per-family income by over 30%.  This economic progress resulted in more acculturation and social acceptance.  For example, by this timeframe, a majority of Japanese Americans spoke English exclusively.

An interesting observation can be made from the Japanese immigration experience.  It appears that their willingness to work and their taking advantage of educational opportunities resulted in rapid improvement in their economic condition and an increase in their social acceptance into the mainstream of society. 

Chinese: Chinese immigrated to the US during the 18th Century.  The Chinese population in the US dropped to approximately 60,000 in 1920 due to the Chinese Exclusion Act and other factors.  However, the Chinese are the largest Asian population in the US today.

Merchants and skilled laborers were generally accepted into society.  However, subsequent groups of unskilled workers encountered negative and hostile attitudes toward them.  These Chinese tended to live in large cities and formed ethnic enclaves called Chinatowns.  The general trends in these enclaves were to restore their homeland’s social norms and somewhat resist integration into the mainstream culture.

As time passed, the cultural division between the Chinese and the Americans diminished.  Chinatowns become a quiet, colorful tourist attraction, and China was an ally of the US during WWII.   This and other factors led to the repeal of the Chinese Exclusion Act.  Consequently, immigration from China resumed.

  Irish: Approximately 1.5 million immigrated to the US during the mid-1800s to escape a serious potato famine.   Most settled in the Northeast and have made a successful transition into the US culture.

Germans: Approximately 4 million immigrated to the US during the mid-1800s to escape economic depression and political unrest.  German immigrates have demonstrated a high degree of acculturation into the American way of life.

Danes, Norwegians, and Swedes: Approximately 1.5 million immigrated to the US during the late 1800s to escape poverty.  The acculturation experiences have been similar to the Germans.

Poles: Approximately 1 million immigrated to the US during the late 1800s and early 1900s to escape poverty, disease, and political repression in their homeland.

Jewish: Approximately 2.5 million immigrated to the US in the late 1800s and early 1900s to escape religious persecution.   The Jewish people encountered religious persecution in the US but were able to survive their difficulties and become accepted into American society.  Jewish immigration has continued throughout the last 200 years, with a corresponding increase in their acceptance throughout society.

  

Austrians (Czechs, Hungarians, and Slovaks): Approximately 4 million immigrated to the US during the late 1800s and early 1900s to escape poverty and overpopulation.

  

Italians

Approximately 4.5 million immigrated to the US in the late 1800s and early 1900s to escape poverty and overpopulation.  They have been very successful in adapting to the American way of life.

  

Mexicans

Approximately 700,000 immigrated to the US in the early 1900s to escape the Mexican Revolution of 1910 and the difficult social and economic conditions in Mexico at that time.   Also, approximately 2 million Mexicans immigrated to the US in the mid-1990s to escape unemployment and poverty.

  

Cubans

Approximately 700,000 immigrated to the US in the late 1900s to escape the communist takeover.

 

Dominicans, Haitians, Jamaicans

Approximately 1 million immigrated to the US in the late 1900s to escape poverty and unemployment.

  

Vietnamese: Approximately a million immigrated to the US in the late 1900s to escape the Vietnam War.  They have proven to be adept at conforming to the new experience of living and working in the US.

  

Africans: Africans were brought to this country against their will during the early history of America.  Given these circumstances, they have done an excellent job coping with the socioeconomic issues they have faced.   They have transformed the difficulties and accepted (and have been accepted by) the American way of life.

Although only some of the major immigrations have been addressed, the reader can sense the rich cultural and social diversity that went into building the American melting pot.  It is important to recognize that every culture has strengths and weaknesses, and generally, the composite is made stronger by the interaction of all of the individuals. 

 We tend to fall into the mindset that cultural diversity means respecting other people’s differences from different nations or different skin colors.  Differences can also present just from upbringing, belief systems such as moral, religious, political beliefs, etc.  Watch the following clip from the popular movie Legally Blonde as an example of very different stereotypes and how they don’t understand each other all right here in our country.

 

 

Race/Ethnicity And Other Social/Health Problems 

In the US, there are four major minority racial, ethnic groups:images-3

  •           African Americans
  •           Hispanic Americans
  •           Asian Americans/Pacific Islanders
  •           American Indians/Alaska Natives

 

These four groups make up approximately one-quarter of the total US population.  They also constitute the fastest-growing segment of the population. Consequently, the need to understand the socio-cultural factors affecting these racial and ethnic groups is crucial for providing adequate social services. 

The US Bureau of Census revealed that African Americans constitute approximately 13.2% of the population, followed by Hispanic Americans (17.4%), Mixed (2.5%), Asian Americans, and Pacific Islanders (5.4%).  There is considerable variation within racial and ethnic groups and between groups, and there is often a complex relationship between racial/ethnic group membership and socioeconomic status.  A good example of this is if an individual has a high degree of acculturation (language, value systems, career, housing, etc.), then that individual could be rejected by their race or ethnic group.

Some minority groups have limited access to social services and are often at higher risk of anti-social behaviors.  This is a consequence of several factors, such as the migration experience, poverty, unemployment, and cultural differences between the minority groups and the mainstream society. Some low socioeconomic status individuals may engage in high-risk behavior for economic reasons.  For example, some may turn to prostitution and/or drug dealing to support their families due to lack of education or vocational training and the resulting limited employment access.

 

 

General Barriers to Social Services 

Racial and ethnic populations may face several problems (language, transportation, etc.) that may impede their social services access.  Individuals from racial/ethnic groups tend to under-utilize healthcare, prenatal care, mental healthcare, substance abuse treatment or seek them as a last resort.  Treatment may be sought only when the resources of the traditional family support network have been exhausted.  At this point, problems may be so chronic and severe that treatment outcomes may be poor.

The individual’s economic status may be a deterrent to the purchase of imgresservices.  Racial/ethnic populations are more likely to have lower incomes than those of the mainstream population but are less insured.   

Those needing social services may live in areas where access to providers is limited because of distance or transportation problems.  Also, those with access may often find services that are inadequate or inconveniently scheduled.  Others may not realize they are eligible or may not be aware of what services a local program offers.   Many social services providers cannot address individuals’ specific needs from cultural backgrounds different from their own, even when they speak the client’s language of origin.  This is further compounded when trying to develop written material for linguistic and culturally diverse populations.   Issues such as literacy levels and regional differences (different dialects) need to be considered when developing written program material.

Beliefs and attitudes regarding health and illness may act as obstacles keeping racial and ethnic populations from seeking treatment for social problems.   The literature on health and mental health has identified a number of factors that contribute to the underutilization of services.  For example, reliance on folk remedies may cause some underutilization of medical services.  Cultural stigmas attached to psychiatric care, psychotherapy, and counseling may invoke fear of losing status and be judged a failure by the family and the community, thereby contributing to underutilization.   Cultures differ in their characterization and acceptance of abnormal behaviors.  For example, what is considered abnormal behavior in one culture may be accepted or encouraged in another.   For example, the practice of voodoo may be accepted in one group and scorned in other groups. Abnormal behaviors may be attributed to physical or psychological causes, or they may be viewed as the direct result of supernatural or spiritual factors.

Emergency rooms often serve as primary care providers for racial and ethnic minority groups in urban areas.  Individuals with long-standing social problems are more susceptible to serious medical problems and are more likely to use emergency rooms.  However, emergency rooms often cannot provide appropriate referrals to social services or provide follow-up to assure appropriate care is provided.

 

Regardless of the services required, racism on an institutional or individual level can be a significant barrier to effective treatment.  Institutional racism within a service ocd4rganization is evident when the program design is oblivious to its client population’s racial, cultural, or ethnic backgrounds, values, and morals.    Latent prejudices on the part of the staff and language and cultural differences undermine efforts to help patients achieve recovery.

A community in social and economic turmoil may reject social service providers who are outsiders.  Negative experiences with providers who may have lacked respect, awareness, or concern for cultural differences often reinforce unfavorable attitudes and distrust.  For example, some treatment programs may be rendered ineffective if the community has not been involved in their planning and implementation.

 

Cultural Competence

The importance of culture increases in individuals living in a socio-cultural setting other than the one they came from.  Also, for those who have not experienced socio-cultural change, cultural issues may come to the forefront in interactions with individuals who do not share the same culture of origin. Such encounters prompt the realization that different cultures view the world in different ways.  A way to help bridge those differences is through the acquisition of knowledge about other cultures.  Cultural knowledge enhances the understanding of different views and also helps to develop more effective problem-solving strategies. 

A cultural competency program is one that demonstrates sensitivity and understanding of cultural differences.  It is a fundamental ingredient that helps develop trust and understand how members of different cultural groups define health, illness, and health care. Consequently, culture is a set of academic and interpersonal skills that allow individuals to increase their understanding and an appreciation of cultural differences and similarities within, among, and between cultural/ethnic groups.

A culturally competent social service provider recognizes and utilizes the client’s strengths, values, and experiences while encouraging behavioral and attitudinal change.  Culturally responsive services generally focus on the following: 

  •           Knowledge of the client’s native language
  •           Sensitivity to the cultural mores of the client population
  •           Staff background similar to clients
  •           Treatment/services modalities that include values of the client population
  •           Representation of the client population in decision-making and policy implementation.

It has been recommended that cultural competency programs need to implement cultural competence at all levels:  Policy, structure, attitude, staff, and policy.  Stated slightly differently, culturally competent systems include professional behavioral norms built into the organization’s mission, structure, personnel, and program design and treatment modalities.

Cultural competence also infers professionals’ willingness and the programs they operate to conduct self-appraisals to understand how they may differ from the clients they serve.  Cultural competence also entails the acknowledgment of existing inherent cultural biases on one’s attitude and behavior.  A provider’s discomfort in relating to individuals who are different can be communicated in many non-verbal ways.  Common factors that influence comfort include ethnic and racial characteristics, socioeconomic background, religion, and physical and mental handicaps.  However, cultural competence requires communication that goes beyond language proficiency to focus on meanings and interpretations.  Consequently, within a culturally competent framework, knowledge of cultural beliefs and expectations are necessary for effective communication.

Georgetown University developed the conceptualization of a continuum of cultural competence in 1989.  It can be used to assess the level of cultural competence.  It includes:   

 CULTURAL DESTRUCTIVENESS:  Attitudes, policies, and practices that are destructive to other cultures.

CULTURAL INCAPACITY:  Lacks the capacity to help but is not intentionally destructive.

CULTURAL BLINDNESS:  Attempts to treat all people as though they are alike.  It infers that one’s color or culture does not matter.  Services are so culturally neutral; they are not relevant to anyone.

CULTURAL PRE-COMPETENCE:  Individuals or agencies realize they have weaknesses in their cultural competence and attempts to improve.  The risk at this stage is that token change may be accepted as sufficient.

CULTURAL COMPETENCE:  Others are accepted and respected for their differences, and cultural knowledge is continually expanded.  In program settings, staff committed to their particular culture are hired; staff is encouraged to become comfortable working in cross-cultural situations.

CULTURAL PROFICIENCY:  Different cultures are held in high esteem: agencies and staff advocate and work to improve relationships among cultures throughout society.

The melting pot continues to blend people from all cultures into one person.  I think the great American experiment has proven successful, as we have adopted each culture’s strengths into the mainstream culture.  Again, we have made a lot of progress, but there remains a lot of work to be done.

 

 

LANGUAGE CONSIDERATIONS

imagesOne of the greatest barriers to the acculturation of racial/ethnic groups into the American way of life is language.  Most early immigrants that came to the US did not speak, read, write, or understand spoken English.  Fortunately, some of the more recent immigrants have a better command of the English language. However, problems still exist, especially with low socioeconomic individuals who migrate to the US to avoid poverty and unemployment in their native country.  The following paragraphs will introduce the reader to the general language problem:

19.2 million Americans are classified as Limited English Proficient.  An increase of approximately 48% from the 1990 Census. 

Due to these factors and other considerations, OSHA requires that employers establish effective communication with non-English speaking workers. Again, some progress is being made, but there is a long way to go.  An employer can bridge the gap to recognize the need for language interpreting and translation services.  Employers may also hire and train bi-lingual staff and translate safety-sensitive documents into native languages. The employer may also provide cultural diversity training for all staff.

Mass racial violence in the United States can include such disparate events as:

  • The racially based communal conflict against African Americans that took place before the American Civil War, often in relation to attempted slave revolts, and after the war, in relation to tensions under Reconstruction and later efforts to suppress black voting and institute, Jim Crow
  • The conflict between Americans and recent European immigrants in the 19th and 20th centuries
  • Between Asian Americans and White Americans during and after the Gold Rush, culminating in the Chinese massacre of 1871 and the Rock Springs massacre.
  • Attacks on Native Americans and Americans over the land (see also: California Genocide, List of Indian massacres)
  • Frequent fighting among various ethnic groups in major cities, specifically in the Northeast and Midwest United States throughout the late 19th century and early 20th century, as fictionalized in the 1957 stage musical West Side Story and its 1961 film adaptation, depicting ethnic conflict in New York between Puerto Ricans and Italians.
  • Anti-immigrant violence targeted at Latin Americans in the 20th century
  • Two concurrent but distinct patterns of disturbances in the civil rights era: racial disturbances resulting from demonstrations and protests, as at the Marquette Park Illinois march of August 1966 or at the 1969 Greensboro uprising in North Carolina, as opposed to the Ghetto riots in the United States (1964–1969), a grouping that includes the Long, hot summer of 1967 and the King assassination riots of 1968, which caused mass violence, looting, and long-lasting damage within African-American communities.

 

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