From Mastery to Accountability: Cultural Humility as an Alternative to Cultural Competence

Cultural competency has been a long held ideal for social work educators and practitioners. However, definitions and approaches to cultural competency vary widely depending on worldview, discipline, and practice context. Within social work and beyond, cultural competency has been challenged for its failure to account for the structural forces that shape individuals' experiences and opportunities. In contrast, the concept ofcultural humility takes into account the fluidity of culture and challenges both individuals and institutions to address inequalities. This article takes a critical look at cultural competence as a concept, examining its explicit and implicit assumptions, and the impact these assumptions have on practitioners. It suggests that cultural humility may offer social work an alternative framework as it acknowledges power differentials between provider and client and challenges institutional-level barriers. The authors advocate a move from a focus on mastery in understanding ‘others’ to a framework that requires personal accountability in challenging institutional barriers that impact marginalized communities. Cultural humility, while a promising concept, has not been fully explored in social work. Therefore, the authors present a conceptual model of cultural competency along with strategic questions for providers and organizations to integrate into social work practice and education.     

Short-Term Home Visiting for Parents

The purpose of this article is to review various aspects of home-visiting programs that have shown to be effective in recent literature to inform policy makers, practitioners, and other involved stakeholders of the current best practices or limitations and to discuss future recommendations based on the literature. Areas of review include intervention design, home-visitor qualifications to fit program design, ongoing staff training and supervision, cultural competency, family-centered approaches, and appropriate intensity and duration through frequent home visiting. Home visiting demonstrates many promising outcomes, as well as challenges, and home-visiting programs would benefit most from more research and more collaboration between programs, service providers, policy makers, and funding sources.     

Training child welfare workers from an intersectional cultural humility perspective: a paradigm shift

The increasing diversity of the populations encountered and served by child welfare workers challenges cultural competence models. Current concerns focus on the unintentional over-emphasis on shared group characteristics, undervaluing unique differences of individuals served, and privileging worker expertise about the client's culture, thereby exacerbating the power imbalance between them. This article promotes cultural humility in child welfare service delivery as a compliment to cultural competence, to liberate workers from expectations of cultural expertise about others, and to actively engage the clients, inclusive of their cultural differences, in the service delivery process. Skills and practice principles are discussed.     

The Journey Toward Intercultural Sensitivity

Abstract

This paper reports on the use of Milton Bennett's Developmental Model of Intercultural Sensitivity (DMIS) to analyze logs that were submitted by mental health service providers who participated in an intensive training program on intercultural competency. Program participants wrote eight monthly reflective logs about cultural experiences that occurred between training sessions. The categories of intercultural sensitivity described in the DMIS were used as the basis for coding log entries. The findings over the 10-month training period show that the development of intercultural sensitivity is, for the most part, a non-linear process in which one makes intermittent reversions to earlier levels and moves forward in spurts. After offering examples of non-linear and linear patterns in the logs, the paper discusses possible explanations for the findings and the challenges of coding according to the Bennett Model. Implications for intercultural competency education and training programs and their evaluation are proposed.     

The Effects of the Healthy Families America Home Visitation Program on Parenting Attitudes and Practices and Child Social and Emotional Competence

This study examined the effects of a Healthy Families America (HFA) credentialed home visitation program on the parenting attitudes and practices of a sample of at-risk parents. It also examined the social and emotional competence of children whose parents successfully completed the program. The HFA model is an intensive early intervention program that targets at-risk families through home visitation services. Successful completion of the program is a process that takes between 3 and 5 years. Results indicate that, relative to the baseline, parents who completed the program showed significant positive change in parenting attitudes and practices. In addition, relative to other children their age, the children of families who successfully completed the program exhibited significantly higher levels of performance on measures of social and emotional competence.     

Examining the need for cultural adaptations to an evidence-based parent training program targeting the prevention of child maltreatment

Evidence-based behavioral parent training programs (BPTs) have been recommended as a primary prevention strategy for child maltreatment, and use of BPTs is increasing. As these programs are implemented in new contexts and among new populations, the cultural relevance of these programs and need for adaptations or modifications must be considered. The purpose of this study was to assess the types of cultural adaptations that are being made to a widely implemented BPT, SafeCare, by providers working with families involved in the child welfare system, and to explore the need for more systematic adaptations. Eleven SafeCare providers, from six states, participated in individual, semi-structured interviews. Overall, the providers did not recommend systematic adaptations of the model for specific ethnic groups. However, they provided general and specific information regarding SafeCare components that require adaptation on a case-by-case basis, which is likely to be applicable to many BPTs. More research is needed to develop clear guidance about when and how to assess the need for cultural adaptations and how to institute adaptations that improve rather than weaken evidence-based programs. By sharing data and experiences, purveyors can contribute to the body of knowledge about adaptation.     

Validity in an evaluation of Healthy Families Florida—A program to prevent child abuse and neglect

Evidence-based continuums have become a guide for identifying the level of evidence in evaluations of home visiting programs conducted to determine their effectiveness in preventing child abuse and neglect. While randomized controlled trials are required for the highest levels of evidence, quasi-experimental designs have also been specified as an appropriate alternative. Using a quasi-experimental evaluation of a home visiting program to prevent child abuse and neglect that adheres to the Healthy Families America model, this paper describes and illustrates how types of validity can be improved. More specifically, we address how threats to internal validity can be identified and reduced through statistical techniques; how construct validity may be strengthened using state records to measure the outcomes; and how external validity is affected by including or excluding study participants. After applying a variety of statistical adjustments to reduce selection bias, we found that the outcomes favored the home visiting program and increased after accounting for covariates that contributed to child abuse and neglect. This was true across the statistical techniques (traditional covariate and propensity score adjustment) used. For evaluations using quasi-experimental designs, recommendations relevant to the illustrations in the paper are also presented.     

Complexities of cultural difference in social care work in England

The ageing of the ethnic minority population in Britain has led to a more ethnically diverse older client group for social care services than has ever been the case. This article focuses on the issue of how social care staff in England experience working across differences of culture, ethnicity, religion, and language. First, the article critically discusses the concept of cultural competence. Then, it reports on the perspectives of social care staff on their attempts to work in a culturally competent way. Individual in-depth qualitative interviews were carried out with 39 social care practitioners, and thematically analysed. Themes related to professional competence, appropriate behaviour, and training needs. Some practitioners felt unable to perform to their accustomed skill level when working across diversity, which has implications for the quality of care provided and job satisfaction. Other practitioners were confident in working across diversity. The key difference between these practitioners was a degree of cultural reflexivity. Recommendations for training are provided.     

Using portable computers in home visits: Effects on programs, data quality, home visitors and caregivers

Collecting and using high-quality data related to participant outcomes are critical for monitoring program quality in home visitation programs for child abuse and neglect prevention, as well as for efforts to improve effectiveness and use limited funds efficiently. An evaluation was conducted to determine the impact of using portable computers to record data from standardized screening tools during home visits. Six home visiting agencies participating in the Early Years Home Visitation Outcomes Project of Wisconsin implemented computerized screenings with wireless uploading of data to a state public health database. Using portable computers saved agencies time and money on all four screening tools tested, with significant cost savings (p < 0.05) on three of the four tools, as compared to paper-and-pencil administration of screenings and manual data entry. The average time used per screening dropped between 9 and 63 min, saving agencies between $2 and $14 per screening administration. Screening completion was also higher when portable computers were used for data capture. There was little effect on home visitors' perceptions of the ease of data collection or their interactions with families being served. The use of portable computers to collect standard screening data holds promise for the field of home visitation.     

Organizational structure,leadership and readiness for change and the implementation of organizational cultural competence in addiction health services

Increasing representation of racial and ethnic minorities in the health care system and on-going concerns about existing health disparities have pressured addiction health services programs to enhance their cultural competence. This study examines the extent to which organizational factors, such as structure, leadership and readiness for change contribute to the implementation of community, policy and staffing domains representing organizational cultural competence. Analysis of a randomly selected sample of 122 organizations located in primarily Latino and African American communities showed that programs with public funding and Medicaid reimbursement were positively associated with implementing policies and procedures, while leadership was associated with staff having greater knowledge of minority communities and developing a diverse workforce. Moreover, program climate was positively associated with staff knowledge of communities and having supportive policies and procedures, while programs with graduate staff and parent organizations were negatively associated with knowledge of and involvement in these communities. By investing in funding, leadership skills and a strategic climate, addiction health services programs may develop greater understanding and responsiveness of the service needs of minority communities. Implications for future research and program planning in an era of health care reform in the United States are discussed.     

The queer youth cultural competency (QYCC) scale: Measuring competency in direct-care behavioral health workers

Sexual and gender minority (SGM) youths are disproportionately represented in behavioral health treatment settings, and face disparities in outcomes when compared to their non-SGM peers. These youths need workers who are culturally competent in addressing their specific needs. This article presents a scale to measure the SGM-related cultural competence of direct care workers. The scale, named the Queer Youth Cultural Competency (QYCC) scale, fills a gap in the measurement literature and enables social workers to more robustly address the cultural competency of service providers as it relates to lesbian, gay, bisexual, transgender, queer, and questioning youths receiving behavioral health treatment.     

A model of cultural competency in social work as seen through the lens of self-awareness

Providing effective cultural competency training to social work students is a social work education struggle. This qualitative study, conducted in the United States, addresses this challenge by examining social work educators’ teaching methods for cultural competency by focusing on the self as a part of culture and racism as a part of dominant culture. The findings reveal that the social work educators emphasize the role of self-awareness and cultural awareness in teaching cultural competency. However, they prefer to use multiculturalism, a 1960s ideology, to teach cultural competency and do not invest in teaching anti-racism. These findings shed light on teaching cultural competency and have practical implications in social work education.     

Mixed‐Method Evaluation of Continuing Professional Development: Applications in Cultural Competence Training

Continuing professional development has been identified as an important tool for advancing the competence of social workers, yet outcomes of professional development are conventionally evaluated using methods that cannot provide trustworthy information about program effectiveness. This paper suggests that innovations in social research can be applied to strengthen the evaluation of educational outcomes from continuing professional development. The benefits of designing a mixed‐method evaluation of educational interventions are explored by reviewing the experience of implementing a cultural competence continuing professional development workshop series in Toronto, Canada. Review of the process demonstrates that the combination of methods results in a richer data set that can answer questions about both the process of the learning experience, and the effect that training has on professional practice.     

Destabilisation and cultural literacy

There is a growing body of work on the field of what is now known as ‘cultural literacy’, but little has been written about its application, and even less on how to teach it in the context of higher education. This article discusses ‘destabilisation’ as an approach to teaching cultural literacy in higher education in the context of the global challenges that universities face today. It defines the characteristics of destabilisation and highlights its advantages in relation to other teaching approaches that have a similar focus on developing cultural competence in students. The article also situates ‘destabilisation’ as a pedagogical term within a spectrum of experiential learning methods and techniques that are focused on developing cultural competence.     

Organizational characteristics that foster early adoption of cultural and linguistic competence in outpatient substance abuse treatment in the United States

Recent years have seen an increased interest in developing culturally and linguistically responsive systems of care in substance abuse treatment in the United States. This study examines the extent to which external and internal organizational pressures contributed to the degree of adoption of culturally and linguistically responsive practices in the nation's outpatient substance abuse treatment system early in the period of development of this system of care. Findings show that a higher degree of adoption of culturally competent practices was most likely in treatment programs with high dependence on external funding and regulation. Internally, programs with a larger number of professionals were associated with the lowest degree of adoption, while managers’ cultural sensitivity contributed significantly to a high degree of adoption of these responsive practices. Considering the passage of recent legislation enforcing the use of cultural and linguistic competence in health care, implications of these baseline findings on early adoption patterns are discussed for future research and health care policy evaluation.     

Does Affirmative Training Matter? Assessing CFT Students’ Beliefs About Sexual Orientation and Their Level of Affirmative Training

This study examined couple and family therapy (CFT) students’ beliefs about sexual orientation, their self-reported competency working with lesbian, gay, and bisexual (LGB) clients, and the level of affirmative training students received in their CFT programs. One hundred and ninety students from accredited CFT programs completed the study. While participants reported feeling only somewhat competent to work with LGB clients and less than half reported receiving any training on affirmative therapy, the majority of the participants did appear to hold positive attitudes toward LGB clients. The results support the literature arguing for CFT programs to include specific training on affirmative therapy practices, as the level of affirmative training was directly related to participants’ self-reported clinical competency working with LGB clients.     

The essential role of cultural safety in developing culturally-relevant prevention programming in First Nations communities: Lessons learned from a national evaluation of Mental Health First Aid First Nations

Mental Health First Aid is a population health approach that educates people to recognize and respond to mental health challenges. Since 2012, the Mental Health Commission of Canada has worked with six First Nations communities to develop a culturally-relevant version of the program called Mental Health First Aid First Nations (MHFAFN). This paper presents mixed methods, multi-informant data from a national evaluation to assess the extent to which the course was experienced as culturally safe by Indigenous participants, factors that contributed to these experiences, and ways in which cultural relevancy of MHFAFN can be improved. Our evaluation team conducted participant interviews and surveys, as well as facilitator interviews. Nearly all Indigenous participants (94.6%) experienced the course as safe. Participants and facilitators identified a range of factors that promoted cultural safety, including the knowledge and skills of the facilitators and the cultural components of the course. Participants that did not experience safety identified trauma-related factors and facilitation style. The findings suggest that MHFAFN may be situated in a way where shared cultural backgrounds are imperative to the success of the course. Further evaluation of the MHFAFN curriculum, with the goal of continual improvement, may help to further enhance participants’ experiences in taking the course.     

Making space for racial dialogue: our experience in a marriage and family therapy training program

Marriage and family therapy (MFT) training programs need to create opportunities for all students to develop cultural competency by raising their racial awareness and sensitivity. Likewise, therapists of color need to be offered space in MFT programs to voice their experiences and venues for their voices to be heard. This article reports on the efforts within a master's level, accredited MFT training program to create space, through participatory action research, for the unique experiences of therapists of color and White therapists who are deeply committed to racial sensitivity.     

Using formative research to tailor a community intervention focused on the prevention of chronic disease

This case study attempts to illustrate and address in-depth the issues surrounding the collection, analysis, and application of formative research findings to program development and implementation. We provide an in-depth case study of tailoring a program for the residents of Berkshire County, Massachusetts. The formative research process includes collection and analysis of secondary data sources, extensive in-person interviews with community leaders, and in-depth focus groups with members of the population of interest. Findings from the formative research are then applied to tailoring the program materials and presentations and the training of the integrative team of health professionals that offer the program. Distinct components of program are tailored to the realities of the social, cultural, historical, and health and medical contexts in each community while other components of the program are tailored to individual participants. Overall, we believe this case study fully illustrates the utility of formative research in tailoring evidenced-based programs to increase program relevance and positive outcomes while maintaining fidelity to a program’s learning objectives and evaluation. We hope this in-depth account with specific examples proves useful as a guide to others when designing and conducting formative research to tailor health and medical interventions to the audience.