Culturally Responsive Practice

Presented by: Fatima Saleem Joe Enright

What is Culture?
Definitions:

* Culture is a set of shared assumptions where people can predict each

others actions in a given circumstance and react accordingly 1975 as cited in Lee, Blando, Mizelle, & Orozco 2007) .
(Haviland,

* It is the customary beliefs, social norms, and material traits of a

racial, religious, or social group.
(Merriam-Webster, 2006)

* Integrated pattern of human knowledge, belief, and behaviour that

is both a result of and integral to the human capacity for learning and transmitting knowledge to succeeding generations. Culture thus consists of language, ideas, beliefs, customs, taboos, codes, institutions, tools, techniques, works of art, rituals, ceremonies, and symbols. An individuals attitudes, values, ideals, and beliefs are greatly influenced by the culture (or cultures) in which he or she lives. (Encyclopedia Britannica, 2011)

What is Culture?
The A.D.D.R.E.S.S.I.N.G. Model: Potential Sources of Cultural Influence (Hayes, 2008):

* Age * Developmental and acquired Disabilities, * Religion * Ethnicity * Socioeconomic status * Sexual orientation * Indigenous heritage * National Origin * Gender

Importance of Culture in Practice

(Lee, Blando, Mizelle, & Orozco 2007)

*Counseling occurs in a cultural context. *Assessment of clients problem (culture). *Counseling itself is culturally based. *Culture itself may be the focus of
counseling.

Ethical Issues Surrounding Culturally Responsive Practice

Principle I: Respect for the Dignity of Persons
CANADIAN CODE OF ETHICS FOR PSYCHOLOGISTS, Third Edition (CPA, 2001)

VALUES: * Psychologists acknowledge the equality of all persons, and that the value of a person is not determined based on cultural background or other characteristics.

Ethical Issues Surrounding Culturally Responsive Practice

PRINCIPLE I STANDARDS General Caring

* I.2 - Not engage publicly (e.g., in public statements,

presentations, research reports, or with clients) in degrading comments about others, including demeaning jokes based on such characteristics as culture, nationality, ethnicity, colour, race, religion, sex, gender, or sexual orientation.

Non-Discrmination * I.9 Not practice, condone, facilitate, or collaborate with any form of unjust discrimination. * I.10 Act to correct practices that are unjustly discriminatory. * I.11 Seek to design research, teaching, practice, and business activities in such a way that they contribute to the fair distribution of benefits to individuals and groups, and that they do not unfairly exclude those who are vulnerable or might be disadvantaged.

Ethical Issues Surrounding Culturally Responsive Practice

PRINCIPLE I STANDARDS Freedom of Consent

* I.30 Respect the right of persons to discontinue participation or

service at any time, and be responsive to non-verbal indications of a desire to discontinue if a person has difficulty with verbally communicating such a desire (e.g., young children, verbally disabled persons) or, due to culture, is unlikely to communicate such a desire orally.

Privacy * I.38 Take care not to infringe, in research, teaching, or service activities, on the personally, developmentally, or culturally defined private space of individuals or groups, unless clear permission is granted to do so.

Ethical Issues Surrounding Culturally Responsive Practice

Principle II: Responsible Caring
CANADIAN CODE OF ETHICS FOR PSYCHOLOGISTS, Third Edition (CPA, 2001) VALUES:

* Psychologists are responsible for ensuring that cultural ignorance

or bias is not a threat to cause harm to clients. * In order to ensure this, psychologists recognize the need for competence and self-knowledge. * Self-knowledge is attained through reflection on how their own

values, attitudes, experiences, and social context influence their actions, interpretations, choices, and recommendations * They consider incompetent action to be unethical due to the risk of harm. They engage only in those activities in which they have competence..

Ethical Issues Surrounding Culturally Responsive Practice

PRINCIPLE II STANDARDS Competence and Self-Knowledge

* * *

II.6 Offer or carry out (without supervision) only those activities for which they have established their competence to carry them out to the benefit of others II.7 Not delegate activities to persons not competent to carry them out to the benefit of others. II.8 Take immediate steps to obtain consultation or to refer a client to a colleague or other appropriate professional, whichever is more likely to result in providing the client with competent service, if it becomes apparent that a clients problems are beyond their competence. II.9 Keep themselves up to date with a broad range of relevant knowledge, research methods, and techniques, and their impact on persons and society, through the reading of relevant literature, peer consultation, and continuing education activities, in order that their service or research activities and conclusions will benefit and not harm others. II.10 Evaluate how their own experiences, attitudes, culture, beliefs, values, social context, individual differences, specific training, and stresses influence their interactions with others, and integrate this awareness into all efforts to benefit and not harm others.

Ethical Issues Surrounding Culturally Responsive Practice

PRINCIPLE II STANDARDS Risk/Benefit Analysis

* * *

II.13 Assess the individuals, families, groups, and communities involved in their activities adequately enough to ensure that they will be able to discern what will benefit and not harm the persons involved. II.14 Be sufficiently sensitive to and knowledgeable about individual, group, community, and cultural differences and vulnerabilities to discern what will benefit and not harm persons involved in their activities. II.15 Carry out pilot studies to determine the effects of all new procedures and techniques that might carry more than minimal risk, before considering their use on a broader scale. II.21 Strive to provide and/or obtain the best possible service for those needing and seeking psychological service. This may include, but is not limited to: selecting interventions that are relevant to the needs and characteristics of the client and that have reasonable theoretical or empirically-supported efficacy in light of those needs and characteristics; consulting with, or including in service delivery, persons relevant to the culture or belief systems of those served; advocating on behalf of the client; and, recommending professionals other than psychologists when appropriate.

Maximize Benefit

Ethical Issues Surrounding Culturally Responsive Practice

PRINCIPLE II STANDARDS Minimize Harm

* *

II.31 Give reasonable assistance to secure needed psychological services or activities, if personally unable to meet requests for needed psychological services or activities. II.35 Screen appropriate research participants and select those least likely to be harmed, if more than minimal risk of harm to some research participants is possible. II.41 Act also to stop or offset the consequences of harmful activities carried out by another psychologist or member of another discipline, when the harm is not serious or the activities appear to be primarily a lack of sensitivity, knowledge, or experience, and when the activities have come to their attention outside of a confidential client relationship between themselves and the psychologist or member of another discipline.

Offset/Correct Harm

Ethical Issues Surrounding Culturally Responsive Practice

Principle III: Integrity in Relationships
CANADIAN CODE OF ETHICS FOR PSYCHOLOGISTS, Third Edition (CPA, 2001) VALUES:

* Trustful relationships are based on honesty, straightforwardness and

openness about potential bias or conflict of interest. * Openness and honesty is enhanced by self-knowledge and the use of critical analysis. Personal values and self-interest can affect every aspect of service. * Psychologists are not expected to be value-free or totally without self-interest. However, they are expected to be open and honest about the influence of such factors, and to be as objective and unbiased as possible.

Ethical Issues Surrounding Culturally Responsive Practice

Principle III: Integrity in Relationships
CANADIAN CODE OF ETHICS FOR PSYCHOLOGISTS, Third Edition (CPA, 2001) VALUES (cont.): * There are times when fully open and straightforward disclosure might not be needed or desired by others and, in some circumstances, might be a risk to their dignity or well-being (Principle I) or considered culturally inappropriate. * Situations that present real or potential conflicts of interest can lead to distorted judgment and can motivate psychologists to act in ways that meet their own interests at the expense of the best interests of members of the public.

Ethical Issues Surrounding Culturally Responsive Practice

PRINCIPLE III STANDARDS Objectivity/lack of bias * III.10 Evaluate how their personal experiences, attitudes, values, social context, individual differences, stresses, and specific training influence their activities and thinking, integrating this awareness into all attempts to be objective and unbiased in their research, service, and other activities. * III.38 Seek consultation from colleagues and/or appropriate groups and committees, and give due regard to their advice in arriving at a responsible decision, if faced with difficult situations.

Ethical Issues Surrounding Culturally Responsive Practice

Principle IV: Responsibility to Society
CANADIAN CODE OF ETHICS FOR PSYCHOLOGISTS, Third Edition (CPA, 2001) VALUES: * Psychologists convey respect for social structures and policies that have developed over time and avoid unwarranted or unnecessary disruption. * On the other hand, if structures or policies seriously ignore or oppose the principles of the Code of Ethics, they have a responsibility to speak out and advocate for appropriate change.

Ethical Issues Surrounding Culturally Responsive Practice

PRINCIPLE IV STANDARDS Respect for Society

* * *

IV.15 Acquire an adequate knowledge of the culture, social structure, and customs of a community before beginning any major work there. IV.16 Convey respect for and abide by prevailing community mores, social customs, and cultural expectations in their scientific and professional activities, provided that this does not contravene any of the ethical principles of this Code. IV.17 Familiarize themselves with the laws and regulations of the societies in which they work, especially those that are related to their activities as psychologists, and abide by them. If those laws or regulations seriously conflict with the ethical principles contained herein, psychologists would do whatever they could to uphold the ethical principles. If upholding the ethical principles could result in serious personal consequences (e.g., jail or physical harm), decision for final action would be considered a matter of personal conscience.

Ethical Issues Surrounding Culturally Responsive Practice

PRINCIPLE IV STANDARDS Development of Society

* *

IV.24 Consult, if feasible and appropriate, with groups, organizations, or communities being studied, in order to increase the accuracy of interpretation of results and to minimize risk of misinterpretation or misuse. IV.25 Make themselves aware of the current social and political climate and of previous and possible future societal misuses of psychological knowledge, and exercise due discretion in communicating psychological information (e.g., research results, theoretical knowledge), in order to discourage any further misuse. IV.26 Exercise particular care when reporting the results of any work regarding vulnerable groups, ensuring that results are not likely to be misinterpreted or misused in the development of social policy, attitudes, and practices (e.g., encouraging manipulation of vulnerable persons or reinforcing discrimination against any specific population).

Culturally Responsive VS. Culturally Competent

Whats the difference?

* For definitional and operational purposes, they are

interchangeable. However

Culturally Responsive VS. Culturally Competent

* Culturally responsive is used in lieu of cultural

competency due to the emphasis of a patient-centered care model. Through use of the word competency, cultural competency alludes to a misleading sense of finality, when in reality life-long self-reflection and new learning are required. (Ring, 2009)

What does it mean to be Culturally Responsive ?

* There is no universally accepted definition of cultural

competence.
(Bonder et al., 2002)

What does it mean to be Culturally Responsive ?

* The provision of ethical and responsive treatment to clients of diverse

cultural backgrounds.
(Parham & Carter, 2009)

* A practitioners ability to understand and address a persons needs within

the individuals socio-cultural context.
(Lynch and Hanson, 1998)

* Being aware of and respecting cultural, individual and role differences of

the client, and practicing only within the boundaries of their competence, while making a reasonable effort to obtain the competence required. (APA, 2002) the possession of knowledge and understanding of the world-views of culturally different clients; and the ability to accordingly develop appropriate intervention strategies. (Sue et al., 1992)

* The capacity to be aware of ones own assumptions, values and biases;

What does it mean to be Culturally Responsive ?

Attempt at a broad comprehensive definition:

*Congruent behaviors, knowledge (including

knowledge of self), attitudes and policies that come together to enable effective work in crosscultural situations. (Cross, Bazron, Dennis, and Isaacs , 1989;
Ring, 2009)

Three Components of Cultural Competence

(Sue, & Sue, 2008)

*Awareness *Knowledge *Skills

(Principle II: Responsible Caring)

(Principle II: Competence and self knowledge)

(Principle II: Maximize benefits)

Potential Barriers
(Truscott, & Crook, 2004)

* Culturally Encapsulated Counselor/Culture Blind * Discrimination * Culture-bound values: individual centered,

verbal/emotional/behavioral expressiveness, communication patterns from client to counselor, openness and intimacy and clear distinctions between mental and physical wellbeing.

(Sue & Sue, 2008)

Potential Barriers Cont.

*Class-bound values: strict adherence to time

schedules (50-minute, once or twice a week meetings), ambiguous or unstructured approach to problems, and seeking long-range goals or solutions

*Language variables: use of Standard English and

emphasis on verbal communication.

How do we become Culturally Responsive as a Discipline?

*Increased training, further research on

intergroup differences. *Development of instruments that are free of cultural bias or alternatively, culturally localized.

How do we become Culturally Responsive as Practitioners?

*Twelve Practical Suggestions for Achieving

Multicultural Competence. (Stuart, 2004)

How do we become Culturally Responsive as Practitioners?

STEP 1 Develop skill in discovering each persons unique cultural outlook.

* *

Change is easier and more meaningful when grounded in acceptance. New ideas are better comprehended when delivered in the clients literal and figurative languages. Use open-ended questions and ethnographic interviews. See DSM-IV Appendix I (APA, 1994).

STEP 2 Acknowledge and control personal biases by articulating your own worldview and evaluating its sources and validity.

* * *

Unchecked bias lead to perceptions that reveal more about therapist than client. Psychologists can benefit by periodically rearticulating their beliefs about human behavior and its management Bidirectional flow between the evolving knowledge base of psychology and clinicians practice wisdom is the only way to achieve responsible operational theories.

How do we become Culturally Responsive as Practitioners?

STEP 3 Develop sensitivity to cultural differences without overemphasizing them.

* *

Despite prominent differences, many aspects of group beliefs and behavior may be common across cultures. Avoid the trap of overgeneralizing

STEP 4 Uncouple theory from culture.

* * *

Researchers have discovered differences between cultures that may be relevant to intervention. Rather than coupling these differences with ethnicity, it may be more helpful to describe the individual traits of the client Focus on the individual, culture is introduced as a mediator or moderator when relevant.

How do we become Culturally Responsive as Practitioners?

STEP 5 Develop a sufficiently complex set of cultural categories. * People have far more diversity than is reflected by labels used by many multiculturalists (eg. Black, Asian, Latino, Middle Eastern, etc.) * Better to describe rather than categorize clients identities. STEP 6 Critically evaluate the methods used to collect culturally relevant data before applying the findings in psychological services. * Cross-cultural research often suffers from methodological flaws. * Translation doesnt guarantee shared meaning. * Subject selection, sample size, and measurement invalidity, are all common weaknesses in literature.

How do we become Culturally Responsive as Practitioners?

STEP 7 Develop a means of determining a persons acceptance of relevant cultural themes.

* * * *

Individuals differ in acceptance of peer-group and cultural beliefs. Many instruments have been developed for this purpose, some more useful than others. Most do not reveal which specific beliefs and practices are accepted, strength of acceptance, or whether acceptance is situation specific. Results may be useful sources of general information to be validated and refined through sensitive, nondirective interviewing.

STEP 8 Develop a means of determining the salience of ethnic identity for each client.

* * *

Ethnicity or culture is only one component that contributes to identity and affect decision making. May not be most salient component at a given moment, or situation. Sensitive assessment involves asking clients to articulate the sources of their perspectives rather than arbitrarily overweighting any one of them solely on the basis of demographics.

How do we become Culturally Responsive as Practitioners?

STEP 9 Match psychological tests to client characteristics.

* * * * *

Selected test must be free of value assumptions and culturally sensitive. Unfortunately most instruments are developed in one culture to evaluate clients identified with another. Normalizing deviant responses to compensate for ethnic influences distorts findings. Evaluate the appropriateness of each instrument, and acknowledge potential cultural bias when reporting results. Benefit of the doubt given when interpreting any abnormal or substandard responses and to consider alternative explanations

STEP 10 Contextualize all assessments.

* *

Easy to find commonalities in the behavior of members of subgroups of a population and attribute these to group typical traits. First identify any common challenges and/or environmental stresses and then consider whether traits could be relabeled as adaptations or coping response s.

How do we become Culturally Responsive as Practitioners?

STEP 11 Consider clients ethnic and world views in selecting therapists, intervention goals, and methods.

* * *

Helping people make changes is difficult. Intervention not likely to succeed when providers do not earn clients trust, use language or concepts that are not understood, or require behavioral or cognitive skills that the clients lack. Intelligent matching removes unnecessary obstacles to effective therapy and enhances outcomes (Morris, 2001).

STEP 12 Respect clients beliefs, but attempt to change them when necessary.

* * * * * *

Being culturally sensitive is to understand the unique way in which cultural values, beliefs, and practices help to create meaning for a client. Insensitivity can decrease the prospect for therapeutic effectiveness. Empathic therapists see the world from the clients perspective, but do not necessarily accept everything in the clients view as healthy. May be appropriate for therapists to attempt to change selected beliefs Knowledge of the belief system helps contextualize problem behavior. Obligation to prevent harm takes precedence over the mandate to respect diversity.

Age: 76 Religion: Islam Language: Non-Native English speaker Nationality: Immigrated to Canada from Oman.