Cultural Sensitivity
A process of Self Awareness and Integration
A Workbook for HFA Sites
Inside this Workbook
Introduction / 3-5What is cultural Competency?
Is culture the only influence on behavior? / 6
6-7
Is my program Culturally Competent? / 7-9
Critical Element #5 / 10-14
Define a Culturally Sensitive Program for Me / 14-15
Cultural Competency in the Context of HFA / 15-16
Determining the Service Population
Standard 5-1 / 17-19
Being Culturally Competent in ALL Aspects of Service Delivery
Standard 5-2 / 19-24
Providing Training to Staff that Supports Their Ability to Provide Culturally Sensitive Services to Families
Standard 5-3 / 24-27
What is a Cultural Sensitivity Review?
Standard 5-4.A / 28-36
Participant Input
Standard 5-4.B / 36-42
Reporting the Annual Cultural Sensitivity Review and taking action on Recommendations. Standards 5-4.D / 42-43
“Each family exists in a specific environmental and social context, and each family adjusts to try and survive and thrive in its given world.”
-David Allen Jones, The Institute on Cultural Dynamics and Social Change
WELCOME
Hello and welcome to “Cultural Sensitivity: A Process of Self Awareness and Integration: A Workbook for HFA Sites.” This workbook will present ideas on what cultural sensitivity means to Healthy Families America, and provide some direction in assessing programs’ fulfillment of Critical Element #5 in the HFA Self Assessment Tool.
HFA is unique in its approach to helping ensure programs strive toward cultural sensitivity and has long since recognized cultural sensitivity as one of the 12 Critical Elements. Critical Element #5 reads: Services should be culturally sensitive such that staff understands, acknowledges, and respects cultural differences among families; staff and materials used should reflect the cultural, linguistic, geographic, racial and ethnic diversity of the population served. Meeting participants where they are, connecting and communicating effectively with parents about the well-being of their children are the basic tenants of HFA. Cultural sensitivity can create avenues around communication barriers that can lead to frustration that can develop between the program, direct service staff, and the families. With an active presence in over 400 communities nationwide.1 HFA sites most likely comes in contact with almost as many different kinds of people as there are residing in the United States.
While culture is often described in terms of group characteristics, a multi-dimensional perspective captures a more individualized, holistic view: “Culture is the combination of thoughts, feelings, attitudes, material traits, and behaviors of a group of people.”2 To be adept in our culturally-laden interactions with families, we must be comfortable with considering our level of cultural sensitivity as individuals and as a program. To accomplish this, cultural sensitivity must be an open-ended, mindful, and measurable initiative integrated into the fabric of site management. Given that credentialing is aimed at quality improvement, the process is an opportunity for all sites to re-examine their vast, ongoing cultural sensitivity initiative. The fact is, since cultural attributes are present in every person at all times, perceived cultural similarities and differences shape all of our interpersonal interactions. We are all constantly responding to what we perceive in our co-workers, participants, friends, neighbors, as their personal cultural climate, and adjusting our conduct in a way that we judge is suitable for successful communication.
Whether or not we are aware of it, “culture” and its influences are ever-constant in all that we do. In striving to find the richness of culture, both our own and that those families we serve, we are able to discover ourselves, our families and the context of their life circumstances. There is increased awareness to do away with the notion that “culture” is exotic and intrinsic to only those who are from groups other than our own. As each of us let go of the mindset that culture is an inconsequential fad, we hone in on an essential and often overlooked key ingredient of effective practice. We are able to “know” that consideration of culture and its influences is an integral ingredient to effective practice.
Critical Element #5 reinforces the need for programs to assess their progress toward providing culturally sensitive services. Ultimately, it requires a program to continually modify or tailor its system of service delivery to the cultural characteristics in its service population including personnel/staff selection, training and development, assessment, service planning and implementation, and program evaluation and participant care monitoring. Essentially, it allows a program to become self aware and integrate culturally sensitive practices based on the unique characteristics of the families in the target and service populations. Thus, monitoring or tailoring your services to meet the unique needs of the families served is a never ending process.
Before getting started on a journey of self awareness and integration as it relates to culturally sensitive services, there are a few things to keep in mind. First, it is important to clarify that this workbook should be used as a starting point for programs; an opportunity to begin to think about culture in a different way. It is best used as a reference or guide, but in no way should be seen as limiting or stifling what some programs may already be implementing successfully. Secondly, the individuals who helped develop and write this workbook are not considered experts and are open to constructive feedback related to the usefulness of this tool. An evaluation has been provided and can be mailed or faxed to Prevent Child Abuse America. Finally, you will notice the words “competency” and “sensitivity” used interchangeably throughout the workbook. In the event that “competency” is used, it is typically based out of research gathered in order to stress the importance of valuing diversity. However, for our purposes, cultural sensitivity (The degree to which the program continually modifies or tailors its system of service delivery to the cultural characteristics in its service population including personnel/staff selection, training and development, assessment, service planning and implementation, and program evaluation and participant care monitoring) as it is defined in the Glossary of Terms in Appendix E of the Credentialing Manual, is the terminology that will be used related to the best practice standards. We hope you enjoy your journey of self awareness and integration.
While there are many different definitions of cultural competency to be found in the literature on this subject, there seems to be three essential components to the concept as it relates to family service agencies:
Ø Behaviors
Ø Attitudes and
Ø Program policies
These components work together to create a system that enables the program and its workers to reach families from different cultures. Once in place, this type of infrastructure helps the program to reach the families it serves within the context of the family’s own culture.
Cultural competence is, by its very nature, a comprehensive, ongoing, evaluative process that exists at the individual, group and system level. In order for it to be effective, it must be integrated into the very core of all the program’s activities, from individual activities to management activities to the program information system.
Is Culture the only influence on behavior?
No. In fact, it is important to see culture in terms of the individual. This will help your program avoid a cookie cutter approach to cultural competency. Programs developing paradigms such as: “all teen mothers do X, Y and Z, while all moms living on J street do A and C.” Judson Hixson stresses that “broad generalizations can mask important contemporary intragroup and intracommunity variations, especially among groups, whose trajectory of cultural evolution has been deliberately and systematically altered, interrupted, or distorted through their encounters with other cultural groups or institutions.”
Hixson goes on to expand the definition of culture in terms of how it shapes our experience of the world around us. Hixson explains that cultural attributes:
Ø “Provide the framework within which we define ourselves individually or as members of one or more groups, including personal and social roles, relationships, and structures we adopt or create;
Ø Serve as a lens or filter through which we interpret and make sense of the world, including how we see our place in it; and
Ø Guide how we interact with, respond to, influence and are influenced by people, events, circumstances and conditions (real or perceived) in our environment.”3
This framework provides direction for cultural sensitivity in home visitation programs. It is essential to connect with families in a way that shows an understanding and appreciation that child-rearing decisions, parenting goals and expectations of discipline, etc. are shaped by cultural attributes that act as a filter for each parent’s experience. Connecting and communicating in a way that is culturally sensitive, is a prerequisite for any meaningful or productive communication at all.
Most experts see cultural competency as a continuum. The following continuum is excerpted from Terry Cross, et. al., in her 1989 Monograph: “Towards a Culturally Competent System of Care.”4
Destructiveness – Attitudes, policies and practices that are destructive to cultures and consequently to the individuals within the culture. The most extreme examples of this orientation are programs/agencies/institutions that actively participate in cultural genocide – the purposeful destruction of a culture. A system which adheres to this extreme assumes that one race is superior and should eradicate the “lesser” cultures because of their perceived subhuman position. Bigotry, coupled with vast power differentials allows the dominant group to disenfranchise, control, exploit or systematically destroy the minority population.
Incapacity – System or agencies do not intentionally seek to be culturally destructive, but rather lack the capacity to help minority clients or communities. The system remains extremely biased, believes in the racial superiority of the dominant group, and assumes a paternal posture towards “lesser” races. The characteristics include: discriminatory hiring practices, subtle messages to people of color that they are not valued or welcome, and generally lower expectations of minority clients.
Blindness – The system and its agencies provide services with the express philosophy of being unbiased. They function with the belief that color or culture make no difference and that all people are the same. Culturally-blind agencies are characterized by the belief that helping approaches traditional used by the dominant culture are universally applicable; if the system worked as it should, all people would be served with equal effectiveness.
Pre-competence – These agencies realize their weaknesses in serving minorities and attempt to improve some aspect of their services to a specific population. Pre-competent agencies are characterized by the desire to deliver quality services and a commitment to civil rights. One danger at this level is a false sense of accomplishment or failure that prevents the agency from moving forward along the continuum. Another danger is tokenism.
Competence – These agencies are characterized by acceptance and respect for difference, continuing self-assessment regarding culture, careful attention to the dynamics of difference, continuous expansion of cultural knowledge and resources, and a variety of adaptations to service models in order to better meet the needs of minority populations. Such agencies view minority groups as distinctly different from one another and as having numerous subgroups, each with important cultural characteristics. Culturally competent agencies work to hire unbiased employees, seek advice and consultation from the minority community, and actively decide what they are and are not capable of providing to minority clients. These agencies provide support for staff to become comfortable working in cross-cultural situations. Further, these agencies understand the interplay between policy and practice, and are committed to policies that enhance services to diverse clientele.
Proficiency – This end of the continuum is characterized by holding culture in high esteem. Culturally proficient agencies seek to add to the knowledge base of culturally competent practice by conducting research, developing new therapeutic approaches based on culture, and publishing and disseminating the results of demonstration projects. Such agencies advocate for cultural competence throughout the system and for improved relations between cultures throughout society.
It is essential for programs to keep in mind that providing culturally competent services is an ongoing process of self-awareness and adaptation. It is not something to achieve, but an ongoing process to better serve families based on their unique characteristics.
Rationale
For home visitor services to be effective it is imperative that cultural context is incorporated into program design and delivery. There are two underlying assumptions to this statement: 1) that the diversity of families is of great significance to intervention programs; and 2) services may be provided by persons whose culture differs from that of the participating family. Thus, in developing home visitor programs, it is important to consider that:
Ø Family needs, health beliefs, coping mechanisms and child rearing practices vary by population - thus, interventions should reflect this variation;
Ø Failure to value diversity in its many forms (e.g., cultural, linguistic, racial, geographic and ethnic) may restrict a home visitor's ability to establish quality relationships with families; and
Ø A home visitor's failure to establish strong relationships with families based on mutual respect and understanding will limit the opportunity for providers and families to work together.
Supporting Literature
While there is no strict empirical support for culturally competent services, efforts to provide services to children and families that are sensitive and responsive to their needs and adaptive strengths have their roots in the late 1800's. When Jane Addams founded the first settlement house in America, it was intentionally located in an area accessible by the preponderance of families in the neighborhood and staffed by providers who lived in the community being served. The success of the settlement house was due, at least in part, to the fact that service providers appreciated the families "indigenous language and cultures, specifically their behavioral norms, rituals, and routines, that is, their agreed-upon shared ways of behaving within constituted family and community groups" (Slaughter-Defoe, 1994, p.175.).
Cultural sensitivity begins during program design. When implementing programs, it is always important to consider that the cultural characteristics of the target population may suggest an alternate or complementary strategy to home visitation. For some groups, the support gained from peers in a group-based setting will be more effective as an agent of change than support delivered in the home. For instance, among Native American Pueblos and traditional Hispanic families, seeking outside support to address family problems is not an accepted practice (Harris-Usner, 1995). By contrast, in rural settings where families do not live in close proximity to one another, home visiting is a more pragmatic strategy than trying to convene a group. These reasons underscore the need for community members and potential participants to be involved in the program design phase.