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The culturally competent system of care is made up of culturally competent institutions, agencies, and professionals. Five essential elements contribute to a system’s, institution’s, or agency’s ability to become more culturally competent. The culturally competent system values diversity, has the capacity for cultural self-assessment, is conscious of the dynamics inherent when cultures interact, has institutionalized cultural knowledge, and has developed adaptations to diversity. Further, each of these five elements must function at every level of the system. Attitudes, policies, and practices must be congruent within all levels of the system. Practice must be based on accurate perceptions of behavior, policies must be impartial, and attitudes should be unbiased. As mentioned earlier, unbiased does not mean color blind; rather it means acceptance of the difference of another.
To value diversity is to see and respect its worth. A system of care is strengthened when it accepts that the people it serves are from very different backgrounds and will make different choices based on culture. While all people share common basic needs, there are vast differences in how people of various cultures go about meeting those needs. These differences are as important as the similarities. Acceptance of the fact that each culture finds some behaviors, interactions, or values more important or desirable than others can help the system of care interact more successfully with differing cultures. In the system of care, awareness and acceptance of differences in communication, life view, and definition of health and family are critical to the successful delivery of services.
The system of care must be able to assess itself and have a sense of its own culture. When planners and administrators understand how that system is shaped by culture, then it is easier for them to assess how the system interfaces with other cultures. System leaders can then choose courses of action that minimize cross-cultural barriers. For example, if “family” refers to nuclear families in one culture and in another culture “family” denotes extended family, then concepts such as “family involvement” will require some adjustment or they simply will not work. Only by better knowing the culture of the existing system of care can the complexities of cross-cultural interfacing be understood.
What occurs in cross-cultural system interactions might be called the “dynamics of difference.” When a system of one culture interacts with a population from another, both may misjudge the other’s actions based on learned expectations. Each brings to the relationship unique histories with the other group and the influence of current political relationships between the two groups. Both will bring culturallyprescribed patterns of communication, etiquette, and problem solving. Both may bring stereotypes or underlying feelings about serving or being served by someone who is “different.” The minority population may exhibit behaviors expressing tension and frustration that the system is uncomfortable with. It is important to remember this creative energy, caused by tension, is a natural part of cross-cultural relations, especially when one of the cultures is in a politically dominant position. The system of care must be constantly vigilant over the dynamics of misinterpretation and misjudgment. Historic distrust is one such dynamic that can occur between a helper of the dominant society and a client of a minority community (Lockart, 1981; Good Tracks, 1973). Part of what they bring to the helping relationship is the history of the relationship between their peoples.
Without an understanding of cross-cultural dynamics, misinterpretation and misjudgment are likely to occur. It is important to note that this misunderstanding is a two way process—thus the label “dynamics of difference.” These dynamics give cross-cultural relations a unique character that strongly influences the effectiveness of the system. By incorporating an understanding of these dynamics and their origins into the system, the chances for productive cross-cultural interventions are enhanced. When people of any culture violate the norms of another there are consequences.
The system of care must sanction and in some cases mandate the incorporation of cultural knowledge in the service delivery framework. Every level of the system needs accurate information or access to it. The practitioner must be able to know the client’s concepts of health and family as well as be able to effectively communicate. The supervisor must know how to provide cross-cultural supervision. The administrator must know the character of the population the agency serves and how to make services accessible. The board member or bureau head must be able to form links with minority community leaders so as not to plan ill-fated interventions.
Mechanisms must be developed within the system to secure the knowledge it requires. The development of knowledge through research and demonstration projects must be made possible. Networks must be built, lines of communication must be opened, and the structure and process of the system must adapt to better respond to the needs of all children. The system must provide cultural knowledge to the practitioner. Information about family systems, values, history, and etiquette are important. However, the avenues to such knowledge are as important as the knowledge itself. Practitioners must have available to them community contacts and consultants to answer their culturally-related questions.
Each element described here builds a context for a cross-culturally competent system of care. The system’s approach may be adapted to create a better fit between the needs of minority groups and services available. Styles of management, definitions of who is included in “family,” and service goals are but a few of the things that can be changed to meet cultural needs. Agencies understanding the impact of oppression on mental health can develop empowering interventions. For example, minority children repeatedly receive negative messages from the media about their cultural group. Programs can be developed that incorporate alternative, culturally-enriching experiences that teach origins of stereotypes and prejudices. By creating such programs, the system can begin to institutionalize cultural interventions as a legitimate helping approach. Only as professionals examine their practice and articulate effective helping approaches will practice improve. Agencies engaging in these efforts add to the knowledge base.
Becoming culturally competent is a developmental process for the individual and for the system. It is not something that happens because one reads a book, or attends a workshop, or happens to be a member of a minority group. It is a process born of a commitment to provide quality services to all and a willingness to risk.
A system of care which is accessible, acceptable, and available to children of color who are emotionally handicapped must be based on a set of underlying values. The literature reveals several common values. These values might be stated as basic assumptions which, when drawn together, provide a foundation for policy, practice, and attitudinal development. It is assumed that a culturally competent system of care:
These assumptions are the starting point for this discussion of the cultural competence model. It is a model based on the belief that it is okay to be different and that the system of care can be enhanced for everyone by making it more responsive to the needs of minority children.
(Portions of this chapter have been adapted from Focal Point, vol.2, #4, Summer, 1988 issue).
Source: Towards a Culturally Competent System of Care, Vol. I
Georgetown University Child Development Center
Washington, D.C.