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Children's Voice Article, July/Aug 2002

Cultural Competence and the "New Americans"

By Sakil Malik and Jorge Velázquez Jr.

U.S. Census data point to our nation's rapidly changing demographics and increased racial and ethnic diversity.1 Over the last decade, immigrants and refugees from Central and South America, Africa, Eastern Europe, and the former Soviet Union--including thousands of children, youth, and families--have come to the United States seeking refuge, asylum, and opportunity. Their arrival has brought increased cultural diversity--and with that has come, in some cases, cultural misunderstandings and confusion.

Most of these "new" Americans have arrived literally with the clothes on their backs. Although they left their native lands for various reasons, many were forced to leave because of civil and political turmoil, such as the Kosovar Albanians of central Europe, who began arriving in the United States in 1999, and the "Lost Boys" of the Sudan, who began arriving in 2000. [See "The Lost Boys: Strangers in a Strange Land," Children's Voice, May 2001.] Others arrive from less developed countries seeking economic opportunity, such as the populations coming from Latin America.

At first glance, when we consider their cultures and histories, we may see these recent arrivals to our shores as vastly different from ourselves, and much more complicated. If we look at ourselves and our own culture, however, we find we have more similarities with these newcomers than we have differences. Most want to develop a sense of belonging, mutual understanding, and respect between "mainstream" society and their individual and diverse cultures.

Changes in the cultural makeup of communities are challenging longstanding institutional and organizational practices in every aspect of human services. Child welfare systems are constantly evolving as they struggle to understand the specific needs of these communities and develop appropriate services for them.

What Is Cultural Competence, and Why Does It Matter?

Culture shapes personal and group values and attitudes. Culture not only influences an individual's beliefs, practices, and behavior, it can influence service outcomes.

By understanding the cultures of the populations they serve, service providers can avoid stereotypes and biases that contribute to disparate treatment of different cultural and ethnic communities. Understanding and respecting culture promotes a focus on the positive characteristics of a particular community and reflects an appreciation of cultural differences. And it is central to developing culturally effective and linguistically appropriate health and human service programs.2

Each of us is influenced by more than one culture, such as our family, our community, and our workplace. Most child welfare providers understand that to do their jobs effectively, they must constantly strive to learn about the cultures of those they serve. Developing an understanding and respect for this diversity is a major step toward cultural competence.

CWLA defines cultural competence as
the ability of individuals and systems to respond respectfully and effectively to people of all cultures, races, ethnic backgrounds, sexual orientations, and faiths or religions in a manner that recognizes, affirms, and values the worth of individuals, families, tribes and communities, and protects the dignity of each.3
Cultural competence is important in every aspect of our public lives, but it is crucial for organizations and professionals who work with new Americans, because they deal with people of diverse needs, cultures, and ethnicities every day.

A culturally competent service provider should:
  • have the knowledge, skill, and attitude to make an accurate community assessment, one that takes into consideration the background and culture of the community being served;

  • have the ability to convey that assessment to community members, to recognize culture-based beliefs about health, behavior, and other basic needs, and to devise solutions that respect those beliefs; and

  • be able to incorporate models of best practice from a variety of cultures into the delivery of child welfare services.
To be culturally competent, service providers must acknowledge culture's profound effect on providers, families, and service outcomes, and be willing to learn more about culture and its importance in the lives of children, youth, and their families.

Why do we need to consider culture? Why does it matter? Is cultural competence a luxury for child welfare providers?

We don't think so. Much has been written about the hazards of ignoring cultural factors in diagnosing and treating the immigrant community. Other research documents the fact that culturally competent care improves diagnostic accuracy, increases ad-herence to recommended solutions, and reduces inappropriate measures. Based on the evidence and collective experience, culturally competent care is not just an ethical nicety, it's a clinical imperative and a financial necessity.4

Indeed, the cultural rights of children and families were asserted by the 1989 UN Convention on the Rights of the Child (CRC), which states that children of ethnic, religious, or linguistic minorities, or of indigenous origin should not be denied the right to enjoy their own culture, practice their own religion, or use their own language with other members of their group. The CRC also calls for children to be educated to help them develop respect for their own cultural identity, language, and values and for civilizations different from their own, and prepare them to live "in the spirit of understanding, peace, tolerance, equality of sexes, and friendship among all peoples, ethnic, national and religious groups, and persons of indigenous origin."5

CWLA, whose Standards of Excellence help define best practice in child welfare services, is working to ensure that its standards, as they are reviewed and revised, are consistent with the principles of the CRC.

Working with New Americans

Cultural competence is a process, not an outcome. Because cultures are constantly evolving, no social work practitioner can hope to be completely familiar with the beliefs of all immigrants and refugees who come to an agency for services--nor can those seeking services realistically expect such encyclopedic awareness from providers.

There is no magic pill for competence, no secret formula for sensitivity. Those who seek to standardize a culture's beliefs and practices are dealing in stereotypes. Nevertheless, everyone can make changes to improve the level of cultural competence in child welfare, whatever their role--service providers, managers, educators, policymakers, and newcomers to this country.

Think and Act

  • Listen and observe.
  • Understand and respect differences.
  • Don't make assumptions.
  • Be empathetic and involved.
  • Involve immigrants and refugees in their own welfare.
  • Learn more about culture, starting with your own.
  • Learn the language, or use a trained interpreter.
  • Ask questions and look for answers.
  • Pay attention to financial issues.
  • Find resources and form partnerships.
  • Use experiential learning.

Service Providers

  • Assess your own cultural competence.

  • Learn about the language, religion, customs, and beliefs of the clients you see most frequently. But remember that culture is dynamic, and that acculturation is always influencing those beliefs.

  • Respect cultural diversity, and value it as an asset.

  • Have personal contact with the communities from which your clients come. Attend community events and festivals.

  • Remember that culture is not homogeneous. There is a great diversity among individuals, even in the smallest ethnic group.

  • Build trust by explaining unfamiliar or intimidating procedures. Tell members of the immigrant community what they can expect throughout the process or course of treatment.

  • Be ready to negotiate or to suggest alternatives to undesirable procedures.

  • Explain to immigrants that the social service system in

  • the United States relies on asking many questions to make a diagnosis.

  • Realize that members of other cultures have different ideas about competent solutions. They may, for example, expect a solution with each office or home visit.

  • Use different media that are familiar to the cultural community. Not everyone reads brochures; many prefer oral communications. Put messages in community newspapers, on television and radio programs, and at community gathering places.

Managers and Administrators

  • Be aware of intercultural program management.

  • Assess your organization's level of cultural competence.

  • Lead the way by arranging for continuous staff training in cultural competence.

  • Develop or update your cultural competence policies.

  • Require all members of the organization--from the receptionist to the CEO--to take continuing education in cultural competence.

  • Hire and retain a diverse staff. Consider building an "international team" to assist with culturally specific care. At the very least, designate one staff person as a cultural resource contact.

Educators and Researchers

  • Teach students of social work about culture and its impact on them and the communities they will serve. Incorporate such teaching into the core curriculum so all students are exposed to it.

  • Help document the impact of culturally appropriate care. Well-conceived research is necessary to demonstrate its cost-effectiveness.

  • Recognize the difference between teaching cultural competence and practicing it. Get involved and put theory into practice in the field.

Policymakers

  • Make continuing education in cultural competence a licensing requirement for service providers.

  • Promote cultural awareness programs in all grades, from preschool through secondary.

  • Establish mentoring programs to integrate young immigrants into social work professions.

Newcomers

  • Recognize your right to follow your own culture.

  • Be willing to teach providers who may be unfamiliar with your culture's practices.

  • Recognize that some home remedies and practices you may be using can interact dangerously with other prescribed solutions, or may be illegal. Tell service providers about all your practices.

  • Be patient with the questions that service providers ask. It is their way of learning and finding out what you need and how they can help.

  • Recognize that you may not receive a solution every time you see a provider.

The Key

Cultural competence is the key to serving any cultural community effectively. Children's well-being depends on our ability to understand and respect other ways of looking at the world. New Americans are here because they want freedom from poverty, war, and religious and political persecution. Cultural competence helps ease the way for optimal development of immigrant and refugee children and ensures that their rights and freedoms are protected.

The principles of culture and cultural competence define the lives of children, families, and communities, and ultimately the work of service agencies and staff. To work effectively with these increasingly diverse communities, we must advance our way of thinking to gain a fundamental understanding of cultural competence and its importance to immigrants, refugees, and all children and families.

Notes

  1. See, for example, U.S. Census Bureau. (2001, March 12). Census 2000 Shows America's Diversity. (Press Release). Available online at www.census.gov/Press-Release/ www/2001/cb01cn61.html. Washington, DC: Author; and U.S. Census Bureau. (2001). Population Profile of the United States: 1999 (Current Population Reports: America at the Close of the 20th Century, P23-205). Available online at www.census.gov/prod/www/abs/popula.html. Washington, DC: U.S. Government Printing Office.
  2. U.S. Administration on Aging. (2001). Achieving Cultural Competence: A Guidebook for Providers of Services to Older Americans and Their Families. Available online at www.aoa.gov/minorityaccess/guidbook2001/default.htm. Washington, DC: Author.
  3. Definition adopted by CWLA in 1991 and revised in 2001. Available online at www.cwla.org/programs/culturalcompetence.
  4. Immigrant Health Task Force, Minnesota Public Health Association. (1996). Six Steps Toward Cultural Competence. Available online at www.crosshealth.com/sixsteps.htm. Minneapolis: Center for Cross-Cultural Health.
  5. UNICEF. (no date). Convention on the Rights of the Child. Available online at www.unicef.org/crc/crc.htm
Sakil Malik is Program Coordinator for CWLA's International Office. Jorge Velázquez Jr. is Director of CWLA's Cultural Competence Division.

For More Information

Child Welfare League of America
440 First Street NW, Third Floor, Washington DC 20002-2085
800/ASK-CWLA
Fax: 202/638-4004
Cultural Competence Division:
culturalcompetence@cwla.org
www.cwla.org/programs/culturalcompetence
International Office:
global@cwla.org
www.cwla.org/programs/international

Other Resources

Center for Cross Cultural Health (CCCH)
1313 SE Fifth Street, Suite 100B, Minneapolis MN 55414
612/379-3573 oFax 612/623-3002 o E-mail ccch@crosshealth.com
www.crosshealth.com

Working to ensure that diverse populations receive culturally competent, sensitive health and human services, CCCH serves as a research and information resource and provides education and training for health and human service providers and organizations.

Center for Multicultural Human Services (CMHS)/National Alliance for Multicultural Mental Health (NAMMH)
701 West Broad Street, Suite 305, Falls Church VA 22046
703/533-3302 o Fax 703/237-2083 o E-mail info@cmhsweb.org
www.cmhsweb.org

CMHS provides a range of mental health, social, educational, health, language, consulting, training, and social services, in 27 languages, geared to the unique values and characteristics of people from diverse cultures. Developed under a grant from the U.S. Office of Refugee Resettlement, NAMMH coordinates efforts to meet the mental health needs of refugees and other cultural minorities.

National Center for Cultural Competence (NCCC), Georgetown University Child Development Center
3307 M Street NW, Suite 401, Washington DC 20007-3935
800/788-2066 or 202/687-5387 o Fax 202/687-8899 o E-mail cultural@georgetown.edu
www.gucdc.georgetown.edu/nccc

NCCC provides training, technical assistance, consultation, and networking, and disseminates information to promote culturally and linguistically competent service delivery systems in health care and mental health.

The National MultiCultural Institute (NMCI)
3000 Connecticut Avenue NW, Suite 438, Washington DC 20008-2556
202/483-0700 o Fax 202/483-5233 o E-mail nmci@nmci.org
www.nmci.org

Through conferences, training and consulting, publications, and specialized projects, NMCI addresses important issues of multiculturalism and works to increase communication, understanding, and respect among people of diverse backgrounds.

U.S. Office of Refugee Resettlement (ORR) Administration for Children and Families Department of Health and Human Services
370 L'Enfant Promenade SW, 6th Floor/East, Washington DC 20447
202/401-9250 o Fax 202/401-5487
www.acf.dhhs.gov/programs/orr

ORR assists refugees and other special populations to achieve economic and social self-sufficiency through programs that offer cash and medical assistance, employment preparation and job placement, skills training, English language training, social adjustment, and aid for victims of torture.

From CWLA Press

Cultural Competence Agency Self-Assessment Instrument
(2002, Revised)
#8404, $16.95

Cultural Competence: A Guide for Human Service Agencies (1999)
By Kimberleigh A. Nash
#7530, $12.95

Five Easy Ways to Order:
Call 800/407-6273 or 301/617-7825
Fax 301/206-9789
E-mail cwla@pmds.com
Online www.cwla.org/pubs
Mail CWLA, PO Box 2019, Annapolis Junction MD, 20701-2019

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