Culturally Responsive Practice A

7/29/2019 Culturally Responsive Practice A

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Presented by: Fatima Saleem

Joe Enright

Culturally Responsive

Practice


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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 (Haviland,

1975 as cited in Lee, Blando, Mizelle, & Orozco 2007).

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


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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


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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.


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Ethical Issues Surrounding

Culturally Responsive Practice

Principle I: Respect for the Dignity of PersonsCANADIAN 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.


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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.


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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 communicatesuch a desire orally.

Privacy

* I.38 Take care not to infringe, in research, teaching, or service

activities, on the personally, developmentally, or culturallydefined private space of individuals or groups, unless clear

permission is granted to do so.


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

VALUES:

*Psychologists are responsible for ensuring that cultural ignoranceor 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..


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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.


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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.

Maximize Benefit

* 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 andthat 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.


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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.

Offset/Correct Harm

* 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.


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Principle III: Integrity in RelationshipsCANADIAN 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 andunbiased as possible.


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

VALUES (cont.):

* There are times when fully open and straightforward disclosure might notbe 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 membersof the public.


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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 andunbiased 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.


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Principle IV: Responsibility to SocietyCANADIAN CODE OF ETHICS FOR PSYCHOLOGISTS, Third Edition (CPA, 2001)

VALUES:

* Psychologists convey respect for social structures and policies that havedeveloped 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.


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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 whichthey 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.


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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 ofprevious and possible future societal misuses of psychological knowledge, and

exercise due discretion in communicating psychological information (e.g., researchresults, 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).


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Culturally Responsive

VS.

Culturally Competent

Whats the difference?

*For definitional and operational purposes, they are

interchangeable. However


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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)


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What does it mean to be

Culturally Responsive ?

*There is no universally accepted definition of culturalcompetence. (Bonder et al., 2002)


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* 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 ofthe client, and practicing only within the boundaries of their

competence, while making a reasonable effort to obtain the competence

required. (APA, 2002)

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

the possession of knowledge and understanding of the world-views ofculturally different clients; and the ability to accordingly develop

appropriate intervention strategies. (Sue et al., 1992)


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Attempt at a broad comprehensive definition:

*Congruent behaviors, knowledge (including

knowledge of self), attitudes and policies thatcome together to enable effective work in cross-

cultural situations. (Cross, Bazron, Dennis, and Isaacs , 1989;Ring, 2009)


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Three Components of

Cultural Competence (Sue, & Sue, 2008)

*Awareness (Principle II: Responsible Caring)

*Knowledge (Principle II: Competence and self knowledge)

*Skills (Principle II: Maximize benefits)


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Potential Barriers(Truscott, & Crook, 2004)

*Culturally Encapsulated Counselor/Culture Blind

*Discrimination

(Sue & Sue, 2008)

*Culture-bound values: individual centered,verbal/emotional/behavioral expressiveness,communication patterns from client to counselor,openness and intimacy and clear distinctionsbetween mental and physical wellbeing.


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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.


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How do we become Culturally

Responsive as a Discipline?

*Increased training, further research on

intergroup differences.

*Development of instruments that are free ofcultural bias or alternatively, culturally

localized.


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Responsive as Practitioners?

*Twelve Practical Suggestions for Achieving

Multicultural Competence. (Stuart, 2004)


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STEP 1

Develop skill in discovering each persons unique culturaloutlook.

* 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 articulatingyour ownworldview 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.


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STEP 3

Develop sensitivity to cultural differences without overemphasizingthem.

* 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.


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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 culturallyrelevant databefore applying the findings in psychological services.

* Cross-cultural research often suffers from methodological flaws.

* Translation doesnt guarantee shared meaning.

* Subjectselection, sample size, and measurement invalidity, are all

common weaknesses in literature.


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STEP 7

Develop a means of determining a persons acceptance ofrelevantcultural 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 refinedthrough sensitive, nondirective interviewing.

STEP 8

Develop a means of determining the salience of ethnic identityfor eachclient.

* 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.


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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 substandardresponses 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 responses.

d b l ll


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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 whennecessary.

* 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 notnecessarily 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.


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Age: 76

Religion: Islam

Language: Non-Native English speaker

Nationality: Immigrated to Canada from

Oman.

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Culturally Responsive Practice A