Challenging Our Views About Cultural Competency
Thursday, January 14, 2016
Dr. Jose Reyes, Cultural Competency Consulting, LLC
Editor's Note: Dr. Reyes will be presenting on cultural competency at the Western Forum for Migrant and Community Health in Portland, OR, February 24-26
The landmark study Unequal Treatment, Confronting Racial and Ethnic Disparities in Healthcare (2003) points us to cultural competency as an important variable in reducing health disparities and delivering equitable services to diverse consumers and families. The takeaway from this study is that providers are essentially the instrument that provides the service and care. In order to attend to the provider, we must reconsider the way we see and understand cultural competency and its applicability to the service of diverse individuals and families.
Many of us have attended some form of training in the area of cultural competency. Traditionally, cultural competency trainings have taught us about the differences we may encounter as a result of being exposed to other cultures. This approach to cultural competency trainings has been disseminated in service-related fields as well as academic training institutions. It is not surprising to find textbooks in academic settings where courses on cultural competency and diversity teach about differences in cultural groups.
Many of the chapters in these textbooks are dedicated to each cultural group and their beliefs, behaviors, customs, or values. Based on this approach, recipients of this information will have a propensity to compartmentalize and generalize the information being taught to all individuals who may be part of each cultural group. For example, if Mexican women are presented as caretakers of the home and children with their husbands/fathers primarily governing decision-making responsibilities (Lipson & Dibble, 2005), individuals that are taught this information will be prone to make generalizations or stereotypes of Mexican women. Although this statement may apply to a segment of this group, the teaching of cultural competency from this perspective can lead toward generalizations that potentially form stereotypical views of cultural groups.
Another interesting variable of presenting cultural competency as a population and “minority” specific approach is that we avoid presenting Caucasians as a cultural group. As an example, Caucasians are the largest composition of adults in the U.S. as well as the largest racial group accessing services in health and healthcare in the U.S. (Racial and Ethnic Disparities in U.S. Health Care: A Chartbook, 2008) and yet this group is not presented as a cultural or racial group when teaching cultural competency.
We must ask ourselves, what is the impact of diminishing or simplifying cultural competency to learning about certain groups and not others? What disservice are we doing by not learning about Caucasians and what message does this send about power and privilege?
In all fairness we cannot say that learning about generalizations of groups has not been useful. We have learned that people from Latin America may speak Spanish as a primary language and that some cultures hold strong values around groups and the collective over individualism. We have also learned that some cultural groups hold the concept of time as a reference rather than an absolute but still this does not apply to every person of that particular cultural group. The danger here is that the more we present and define cultural competency about others, the more we believe that it is not about us.
For providers that buy into this traditional model of cultural competency, it becomes easy to stereotype individuals based on categories. In the absence of challenging our understanding of cultural competency, we continue to train against stereotypes and on the other hand we continue to categorize and teach individuals based on the groups’ affiliation. This type of contradiction is a disservice to many well-intended providers who are not aware of the impact of these contradictions on the service they offer to individuals and families.
Given what we are taught, how relevant is this training content focused on specific cultures to providing culturally sensitive services? Is developing cultural competency skills about learning all the differences of all groups? And if we are realistically able to learn all these differences among all groups, what are the implications of categorizing these groups in our daily work and relationship to diversity?
Cultural competency is a learning process. We are required to think critically about the way we have approached and understand cultural competency. We must discern, integrate and question how the training content may contribute to the stereotyping of cultural groups. While learning new skills it is important that we challenge our preconceived notions about diverse groups and learn from our own experiences in working with communities and customers. This provides an opportunity for us to learn about individuals and their cultures.
Cultural competency is the skills we learn to work effectively in the context of differences. In working on cultural competency the development of skills is essential. Learning about other groups is only one skill of many. Other skills associated with cultural competency include:
· Understanding and knowing the impact of your own culture
· Recognizing, being aware, and developing ways to counteract bias
· Being accepting of cultural differences
· Knowing and managing your limits
· Understanding the impact and function of your privilege and power
· Learning about the experience and history of others
· Recognizing and being familiar with your potential to reduce or contribute to disparities in service
· Being and making yourself accountable to live a life that reflects inclusion - the integration of diversity and cultural competency.
Cultural competency starts with each one of us… the individual provider of service. Cultural competency is a lifelong process requiring continual accountability to work on our skills. This skill model is based on four basic principles:
1. The more you learn about cultural competency, the more you become aware of what you do not know. Therefore, you never arrive or become an expert.
2. Cultural Competency is about skill development.
3. Cultural Competency is a lifelong journey.
4. Cultural competency requires personal accountability – living a life that is congruent with what you learn and say, not something you just do at work but something you live by.
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