| Contents | Previous | Next |
Cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enable that system, agency, or those professionals to work effectively in cross-cultural situations. The word “culture” is used because it implies the integrated pattern of human behavior that includes thoughts, communications, actions, customs, beliefs, values, and institutions of a racial, ethnic, religious, or social group. The word competence is used because it implies having the capacity to function effectively. A culturally competent system of care acknowledges and incorporates—at all levels—the importance of culture, the assessment of cross-cultural relations, vigilance towards the dynamics that result from cultural differences, the expansion of cultural knowledge, and the adaptation of services to meet culturally unique needs. Certainly this description of cultural competence seems idealistic. How can a system accomplish all of these things? How can it achieve this set of behaviors, attitudes, and policies? Cultural competence may be viewed as a goal towards which agencies can strive. Accordingly, becoming culturally competent is a developmental process. No matter how proficient an agency may become, there will always be room for growth. It is a process in which the system of care can measure its progress according to the agency’s achievement of specific developmental tasks. As the tasks are defined, the system will be guided toward progressively more culturally competent services. First, it is important for an agency to internally assess its level of cultural competence.
To better understand where one is in the process of becoming more culturally competent, it is useful to think of the possible ways of responding to cultural differences. Imagine a continuum that ranges from cultural destructiveness to cultural proficiency. There are a variety of possibilities between these two extremes. The six points along the continuum and the characteristics that might be exhibited at each position are as follows:
The most negative end of the continuum is represented by attitudes, policies, and practices that are destructive to cultures and consequently to the individuals within the culture. The most extreme examples of this orientation are programs/agencies/ institutions that actively participate in cultural genocide—the purposeful destruction of a culture. For example, the Exclusion Laws of 1885-1965 (Hune, 1977) prohibited Asians from bringing spouses to this country, immigration quotas restricted their migration, and laws denied basic human rights on the state and federal level. Another example of cultural genocide is the systematically attempted destruction of Native American culture by the very services set up to “help” Indians, i.e., boarding schools (Wilkinson, 1980). Equally destructive is the process of dehumanizing or subhumanizing minority clients. Historically, some agencies have been actively involved in services that have denied people of color access to their natural helpers or healers, removed children of color from their families on the basis of race, or purposely risked the well-being of minority individuals in social or medical experiments without their knowledge or consent
One area peculiar to Native Americans is the Indian Child Welfare Act. This act is an example of a legislative response to culturally-destructive practices. The Act sets up requirements for states regarding placement procedures for Indian children. These requirements are designed to protect children’s rights to their heritage and to protect children as the most valuable resource of Indian people. States must deal with Indian tribes on a govemment-to-govemment basis. While not many examples of cultural destructiveness are currently seen in the mental health system, it provides a reference point for understanding the various possible responses to minority communities. A system which adheres to this extreme assumes that one race is superior and should eradicate “lesser” cultures because of their perceived subhuman position. Bigotry coupled with vast power differentials allows the dominant group to disenfranchise, control, exploit, or systematically destroy the minority population.
The next position on the continuum is one at which the system or agencies do not intentionally seek to be culturally destructive but rather lack the capacity to help minority clients or communities. The system remains extremely biased, believes in the racial superiority of the dominant group, and assumes a paternal posture towards “lesser” races.
These agencies may disproportionately apply resources, discriminate against people of color on the basis of whether they “know their place,” and believe in the supremacy of dominant culture helpers. Such agencies may support segregation as a desirable policy. They may act as agents of oppression by enforcing racist policies and maintaining stereotypes. Such agencies are often characterized by ignorance and an unrealistic fear of people of color. The characteristics of cultural incapacity include: discriminatory hiring practices, subtle messages to people of color that they are not valued or welcome, and generally lower expectations of minority clients.
At the midpoint on the continuum, the system and its agencies provide services with the express philosophy of being unbiased. They function with the belief that color or culture makes no difference and that all people are the same. Culturally blind agencies are characterized by the belief that helping approaches traditionally used by the dominant culture are universally applicable; if the system worked as it should, all people—regardless of race or culture—would be served with equal effectiveness. This view reflects a well-intended liberal philosophy; however, the consequences of such a belief are to make services so ethnocentric as to render them virtually useless to all but the most assimilated people of color.
Such services ignore cultural strengths, encourage assimilation, and blame the victim for their problems. Members of minority communities are viewed from the cultural deprivation model which asserts that problems are the result of inadequate cultural resources. Outcome is usually measured by how closely the client approximates a middle class, non-minority existence. Institutional racism restricts minority access to professional training, staff positions, and services.
Eligibility for services is often ethnocentric. For example, foster care licensing standards in many states restrict licensure of extended family systems occupying one home. These agencies may participate in special projects with minority populations when monies are specifically available or with the intent of “rescuing” people of color. Unfortunately, such minority projects are often conducted without community guidance and are the first casualties when funds run short. These agencies occasionally hire minority staff, but tend to be motivated more by their own needs than by an understanding of the needs of the client population. Such hiring drains valuable resources from the minority community.
Culturally blind agencies suffer from a deficit of information and often lack the avenues through which they can obtain needed information. While these agencies often view themselves as unbiased and responsive to minority needs, their ethnocentrism is reflected in attitude, policy, and practice.
As agencies move toward the positive end of the scale they reach a position called cultural pre-competence. This term was chosen because it implies movement. The pre-competent agency realizes its weaknesses in serving minorities and attempts to improve some aspect of its services to a specific population. Such agencies try experiments, hire minority staff, explore how to reach people of color in their service area, initiate training for their workers on cultural sensitivity, enter into needs assessments concerning minority communities, and recruit minority individuals for their boards of directors or advisory committees. Pre-competent agencies are characterized by the desire to deliver quality services and a commitment to civil rights. They respond to minority communities’ cry for improved services by asking, “What can we do?” One danger at this level is a false sense of accomplishment or of failure that prevents the agency from moving forward along the continuum. An agency may believe that the accomplishment of one goal or activity fulfills their obligation to minority communities or they may undertake an activity that fails and are therefore reluctant to try again.
Another danger is tokenism. Agencies sometimes hire one or more (usually assimilated) minority workers and feel they are then equipped to meet the need. While hiring minority staff is very important, it is no guarantee that services, access, or sensitivity will be improved. Because minority professionals are trained in the dominant society’s frame of reference, they may only be a little more competent in cross-cultural practice than their co-workers. Minority professionals, like all other professionals, need training on the function of culture and its impact on client populations. The pre-competent agency, however, has begun the process of becoming culturally competent and often only lacks information on what is possible and how to proceed.
Culturally competent agencies are characterized by acceptance and respect for difference, continuing self-assessment regarding culture, careful attention to the dynamics of difference, continuous expansion of cultural knowledge and resources, and a variety of adaptations to service models in order to better meet the needs of minority populations. Such agencies view minority groups as distinctly different from one another and as having numerous subgroups, each with important cultural characteristics. Culturally competent agencies work to hire unbiased employees, seek advice and consultation from the minority community, and actively decide what they are and are not capable of providing to minority clients. Culturally competent agencies seek minority staff whose self-analysis of their role has left them committed to their community and capable of negotiating a bicultural world. These agencies provide support for staff to become comfortable working in cross-cultural situations. Further, culturally competent agencies understand the interplay between policy and practice, and are committed to policies that enhance services to diverse clientele.
The most positive end of the scale is advanced cultural competence or proficiency. This point on the continuum is characterized by holding culture in high esteem. Culturally proficient agencies seek to add to the knowledge base of culturally competent practice by conducting research, developing new therapeutic approaches based on culture, and publishing and disseminating the results of demonstration projects. Culturally proficient agencies hire staff who are specialists in culturally competent practice. Such agencies advocate for cultural competence throughout the system and for improved relations between cultures throughout society.
In conclusion, the degree of cultural competence agencies achieve is not dependent on any one factor. Attitudes, policies, and practices are three major arenas wherein development can and must occur if agencies are to move toward cultural competence. Attitudes change to become less ethnocentric and biased. Policies change to become more flexible and culturally impartial. Practices become more congruent with the culture of the client from initial contact through termination. Positive movement along the continuum results from an aggregate of factors at various levels of an agency’s structure. Every level of an agency (board members, policymakers, administrators, practitioners, and consumers) can and must participate in the process. At each level the principles of valuing difference, self-assessment, understanding dynamics, building cultural knowledge, and practice adaptations can be applied. When, at each level, progress is made in implementing the principles, and as attitudes, policies, and practices change in the desired direction, an agency becomes more culturally competent.
(Substantial portions of this chapter have been reprinted from Focal Point, vol.3, #1, Fall, 1988 issue).
Source: Towards a Culturally Competent System of Care, Vol. I
Georgetown University Child Development Center
Washington, D.C.