Cultural
Competence:
How Far Have We Come?
The current issue of Focal Point focuses on "Assessing
and addressing cultural competence in systems of care." Focal Point first examined the issue of cultural competence in 1988,
and the appearance of this new issue invites the question: How far
have we come since that time?
In the intervening years, much has changed, yet much remains the
same. Clearly, the idea of cultural competence has become a central
theme in efforts to build systems of care for children with emotional
and behavioral challenges and their families. Around the country,
people involved in systems of care have developed and implemented
a variety of innovative approaches for increasing cultural competence.
The articles by Lazear & Pires, Arbuckle, and Ortega, et al.
describe some of these strategies and the impact they have had in
systems of care.
 Yet
at the same time, disparities continue in mental health services
for racial and ethnic minorities as compared to Whites. Across child-serving
systems, youth of color tend to be unserved, under-served, or inappropriately
served. The articles by Huang, Breda, and Woodruff document some
of these disparities in great detail.
So how far have we really come? We invite you to reflect on this
question, or on any of the more specific questions raised by the
issue, including:
- Do we have the tools we need? Do our current assessments-whether
self-assessments, or assessments from the perspectives of families,
community stakeholders, or outside observers-provide us with reliable
information? Is this information useful in identifying challenges
and in measuring whether or not we are having success in our efforts
to address these challenges?
- Do we know enough about what cultural competence is? The articles
by Gomez and Walker & Cook suggest that there may be some
discrepancy in the ways that different stakeholders define cultural
competence.
- Where should we go next? What should our priorities be for research,
policy, and applied efforts?
We look forward to hearing from you.
Comments:
 If I may introduce a point that differs from that which would be held by "thinking" alone. It is of some significance that anyone entertaining the notion of "treatment" of a troubled youth look beyond the physical [race, ethnicity, cultural influencing] and realize that which is "causal" behind a troubled youth is the MIND of the youth, and this is not addressed by manipulation of, or attention to the environment surrounding such youth.
Of course those who have been trained in behavioral ideation will be non-consciously frightened of my suggestion, and Scotoma will cause them to discount my suggestion as a means to self-protect their own MINDs by their MINDs quite unknown to them at a cognitive level of awareness.
The fact is every child, regardless of race or culture, operates with the same structure of MIND. Although behavior will naturally reflect the child's cultural habits, the behavior has nothing to do with the treatment the your requires. To imagine that ones culture has a connection to ones mental conflict is popular perhaps, but erroneous relative to fact.
The fact is the troubled youth has a MIND that has taken-on some misperceptions at birth or around birth, and certain actively repressed trauma within one or both parents is/are triggering the misperceptions within the youth's MIND. The behaviors are merely the way in which the youth's MIND "vents" the energy caused by repressing the misperceptions. To treat the youth properly, a competent psychotherapist would assist the youth to access the misperception(s) and eliminate it/them.
The problem is finding a "competeent" psychotherapist in a sea of behaviorists who are dedicated to denying both the MIND and Spiritual realms within the human being.
James W. Patterson, Ph.D.
Posted Saturday, March 24, 2007 at 08:42 AM
I do beleive that if we stick to the RACES, as far as Cultural Competence goes, we can get the basic idea of what each race's basic cultural make-up is.
When we drift from the races "cultural competence" tends to become a free for all meaning everything tends to take on some form of culture, which "dilutes" the purpose of the message of the race cultures.
Race culture has a wealth of information that idenifies the differences as well as allows you to embrace the differences and resepct yourself and others.
posted January 30,2006 Doris A. Weldon Posted Monday, January 30, 2006 by DorisWeldon@nasw-pa.org at 11:35 AM
The definition of culture is one's feelings, ideas, and beliefs. I am a woman of color, however I do not necessarily agree with all women of color or all people of color. My race, alone, does not define me. I do, however, have my own personal beliefs. I beleive that there is a certain way that people should carry themselves (what I consider to be like a lady), I am educated, I am Christian, I am the only daughter out of four children,, but two of them are step-brothers and I have a twin brother. Those are cultures within themselves. Then, you tack on the fact that I have a psychology degree from a historically black catholic university (the only one), I am in a black greek sorority, I work with youth living with mental illness, I am HIV positive at a young age (the list goes on and on), you will see that there are many, many cultures. It's about what you believe and it is more than skin deep. Yes, by now you may have guessed, one culture that I belong to is the African American race, but not all African-Americans consider themselves Christian or have a twin brother or come from a blended family, so they may not be of my same culture. It all depends on what their idea of family is and their idea of religion, education, music, abortion, chronic illness, etc. In reality, my group of associates consists of people who are white, black, hispanic, christian, jewish, atheis, depressed, stressed, content with life, poor, rich, middle class, some have doctoral degrees, some have masters or bachelors degrees, some have yet to receive their degrees. Culture is comprised of many things and to say that it is solely about skin color, is to limit the true meaning and to limit ourselves. Posted Wednesday, December 8, 2004 at 07:54 AM
Too many times, 'cultural competence' workshops seem to emphasize how different 'they' are...how if you memorize '11 Facts for working with' a particular group, you'll now be culturally competent. People aren't that simple; there are all sorts of things that combine to make a person who s/he is, not just ethnicity or religion. In a way, each family is its own culture, and competence in working with a particular family isn't something you go INTO the situation having. In each helping relationship, there's got to be respect and openness to learning about each other, rather than some certificate that proclaims you 'culturally competent'. Posted Monday, June 23, 2003 at 01:39 PM
I think cultural diversity deals with skin color not what people do in their homes. Their is a different culture in my house than in my daughter's. I do not allow smoking, certain music,certain movies, and certain people. I have rules that if you intend to enter my door then you will abide by them. We are the same color but have different. I am a woman of color by ethnic group. I am an american by birth. Providers need to get to know how I think not diagnose me on the book about something or someone whom I have nothing in common with. Mental illness is a big barrier to over come. Providers need to find out what their clients think. Some may be able to tell you why they act as they do. Posted Tuesday, April 22, 2003 at 01:38 PM
I'd like to hear from people of color about the suggestion that cultural competence is too narrowly tied to race. One argument that I've heard to stick to the "four main groups of color" is that if the concept is opened up it will be diluted by the concerns of many special interest groups, many of whom do not share the historical oppression of African Americans, Native Americans, and Asian Americans, and some Latino groups.
Posted Sunday, February 9, 2003 at 03:58 PM
This presents an interesting question. Specifically regarding the issue of potential abuse-- it is not necessarily the case that all physical punishment is abuse. Physical punishment, occasionally administered in a calm and rational way, and within a relationship that is supportive and loving, appears in fact to be a very effective means of discipline. I believe that part of the trouble we have around this issue is that we don't trust parents to be able, or even to learn how to be able, to tell the difference. It's sort of a "just say 'no'" approach that doesn't really work that well in other areas either. Rather than choosing a hard line, black-and-white approach, why would it not be possible to explore with the parents why their current discipline is not working and help them decide how to tailor what they are doing, perhaps by beginning to rely more on positive support, as well as by helping decide if they are administering physical punishment in a calm way, where the reason for punishment is made clear, or in the heat of rage. In our own research on cultural competence, we found that the issue of physical punishment was one of the biggest areas where parents-- particularly African American parents, but also, as mentioned in the previous post, by parents whodescribed themselves ad fundamentalist-- felt that their beliefs and values were not respected by service providers.
More generally, do our failures in cultural competence come from these sorts of areas where we have rigid expectations and can't partner with parents in a more open-minded way? Posted Monday, February 3, 2003 at 08:49 AM
One of the issues in cultural competence is that it is most often apparent in its absence. When people feel respected, comfortable, and listened to, and when the services they are offered are congruent with their values and preferences, "culture" is not apparent because it is imbedded in the situation. On the other hand, when people feel uncomfortable, disrespected, or misunderstood, the mismatch between their values, beliefs, and preferences and the services they are offered lead to "non-compliance," "dropout from treatment," and other undesirable outcomes. These days we still hear of blatantly bad behavior, but often issues of cultural competence are much more subtle.
One example comes to mind - (white) parents who practiced a very fundamental religion were told be a psychologist to ignore the undesirable things that their 10 year old son did, and to emphasize and reward the positive things that he did. Although this is standard, acceptable behavioral practice, the parents could not "go along with" what they felt was contrary to their "spare the rod, spoil the child" teachings. Unfortunately, I don't think they ever communicated their disagreement to the therapist - they just quit going. In fact, the approach suggested probably would have been very good for their son, who was often disorganed and confused, and who seemed to do many inadvertant "bad things." Punishing him probably did make things worse for him, and did not result in better behavior. An opportunity was lost when the family's culture was not explored and taken into account. There probably were ways to support the family's strong beliefs but help to create a more supportive (and therapeutic) environment at home. There was not blatant racism or anti-religism" here - the therapist was simply unaware of how the family's practices were tied to their religious beliefs, and the need for great skill in supporting the child and family through a difficult change process.
I deliberately included this example of a white family because I think "cultural competence" too often is assumed to be related only to people of color. A further assumption is that if we behave in a "nice" (not blatantly racist) way, then cultural competence should not be much of an issue. I hope that this example will stimulate some discussion. For example, should the family have been reported for child abuse? Would the involvement of child protective services have facilitated a more supportive, therapeutic environment at home? Posted Sunday, February 2, 2003 by Long time family advocate at 10:49 AM
i agree. Posted Tuesday, January 28, 2003 by sammie gray at 07:52 AM
One of the first problems, it seems to me, is that cultural competence really is "in the eye of the beholder." Each person who enters services may have a different set of preferences, beliefs, and ideas about help based on his/her culture (not race). So, in order to look at the link, it is necessary to measure cultural competence re: each individual, and to be sure that the outcomes we look at are appropriate for the individual in question. The answer is "probably no" to solid evidence about the link between cultural competence and client outcomes because I don't think we go about studying it the right way.
Posted Thursday, January 16, 2003 by A researcher at 03:39 PM
In response to Harvey Kayne
Hello! My impression is that there is no evidence of a direct link between cultural competence and clinical outcomes. There are, of course, many reasons for this. Possibly the most significant is the lack of clarity around the definition of cultural competence and how to measure it in a difinitive way. Also there is the related issue of separating out the impact of cultural competence versus efforts to implement other system of care values. I am sympathetic to the "heretical" points you raise-- there is obviously a need for clarifying many of these issues, and for doing some basic research where the definitions can perhaps be made clearer. For example, I do believe some research is starting to show that participation does have impact, yet I would also say that on the whole our measures of participation are quite crude. Similarly I have personally been frustrated with the lack of information about the effectiveness of strengths based approaches-- another approach connected to system of care reforms. My own research indicates there is actually a decent reason to believe that these approaches do in fact work, but without good theory it becomes hard to test the proposition. It also becomes very hard to define the activity and to tell when someone is just talking the talk versus walking the walk. We need clearer theories about how this stuff works. Finally, I think it can be argued-- and it seems that your own actions are in line with this-- that cultural competence is a value to be pursued in its own right, even in the absence of clear information about its link to clinical effectiveness. (If we're being heretical, we would have to acknowledge how many other sorts of services-- eg psychotherapy for children-- that we willingly prescribe despite a lack of convincing evidence of effectiveness.) That line of reasoning might bring up issues of cost effectiveness of various program options...
Anyway, I believe these are indeed complex issues. That said, I think our issue shows the progress that has been made in efforts to understand some of this better. Also the dialogue continually raises interesting questions about what we do without having to prove it works, versus what sorts of efforts we need to offer proof for.
I think the Hernandez article cited in the Focal Point article is a pretty good indication of where we are with all this. I personally like the work of Stanley Sue-- there is an article I cite by him on page 36. al setting)His approach looks at cultural competence in psychotherapy. I am hoping to get an article by him for the spring issue which will, I think, be looking at individualizing services.
Sorry not to have better answers. Regards,
Janet Walker, Focal Point editor
Posted Tuesday, January 14, 2003 by FP Editor at 01:08 PM
In regards to the article, "Measuring the Cultural Pulse of
Service Providers" in the Fall 2002 issue of Focal Point I have a question
as to outcomes. I am very glad that the researchers found that the
incredibly well funded, mature systems of care that were built on CASSP
principles and values did, in fact, practice such principles as cultural
competency at a level greater than less integrated (and funded) systems. I
do wonder, however, is there any difference in the clinical outcomes of
service provision by the different systems? I would think that greater
cultural competency should lead to greater consumer acceptance of services,
and, at least to some extent, greater participation in programming. Based on
the notion (proven or not) that greater participation in the therapeutic
process should lead to generally better outcomes (e.g. increased functioning
levels, decreased impairments, decreased utilization of other services such
as juvenile justice involvements, etc.), is this the case? At the risk of
being somewhat of a heretic, or at worse, politically incorrect, does that
which "feels good" translate into real, measurable differences?
I am a firm
believer in paying attention to the families that we serve ( I am the
clinical director of a comprehensive community mental health center serving
children and adolescents) and we attempt to structure what we do based, at
least in part, on feedback gleaned in focus groups and through other means.
We are concerned not merely with cultural competency per se, but with a
focus on the uniqueness of all of our families. Despite some of our efforts
to measure process and or outcomes we certainly haven't learned much about
how this all plays out in terms of the bottom line, that is, does this
directly impact clinical outcomes in a positive manner? Any light you or
the writers of this article can shed on this matter would be greatfully
appreciated. By the way, I truly appreciate Focal Point and regularly share
the contents with the staff here.
Harvey Kayne,Clinical Director
D and E Counseling Center Posted Tuesday, January 14, 2003 by Harvey Kayne at 01:03 PM
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