Cross Cultural Skills & Strategies For Helping Professions

1. Cross Cultural Skills & Strategies For Helping Professions Spring Academy Prevention & Treatment Exchange 2009 C. Truth Griffeth, LCSW, CDP, NCAC truth@nativeinstincts.com 206.399.5846

2. Objectives Gain awareness of own social identity group memberships Examine behavioral consequences and effects of unintentional biases in helping relationships Learn indicators of a professional who is striving for cultural “competency” Review specific clinical considerations for working across difference and practical ways to increase cultural knowledge/skills Share resources for future study

3. Premise: You already have cross-cultural skills You have altered or adapted skills in a cultural context

4. Challenges: Lifetime process: no instant “competence” Breadth vs. depth Challenges and risks involved in exploring this topic in mixed groups—may be first time Complex subject with emotionally charged history and meaning Language, definitions, meanings Success will depend on RISK&ACTION…

5. Reflection Exercise: Exploring and learning about each other’s social identities while reflecting on our own experiences…

6. Power Flower

7. Behavioral Consequences of Misunderstanding: • Reduced retention/participation in tx • Dx: inaccurate, over or both • Staff assignment/time • Tx planning/research not effective • Utilization/advocacy needs • Misunderstood family dynamics and cultural beliefs • Delayed care • Others?

8. Consider Effects of: • “Colorblindness” • Overconfidence/over identification • Stereotyping/dualistic thinking • Acculturation and assimilation • Individual vs. collective identity • Who gets “named”: the creation and perpetuation of “otherness” • Terms like: “Underprivileged” “Underserved” • “Teach me” syndrome: risk, power & invasive questioning

9. Consider Effects of: • Ignorant of—or ignoring— organizational/professional culture and hx • “Reverse” discrimination/affirmative action • Collusion/passivity • “Multiethnic” practice (agenda) • Exclusive language and examples in tx • “Politically correct” (agenda) • Other examples?

10. Striving for Competency…(Adapted from “Readings for Diversity and Social Justice” Adams et al, 2000.) • Accepts the fact that they have much to learn about others and themselves; takes responsibility for learning how oppression works in everyday life • Feels good about own social group membership; is comfortable and proud of own identity • Listens to and respects the perspectives and experiences of target group members

11. Acknowledges unearned privilege(s) and works to eliminate or change into rights that target group members also enjoy • Recognizes that unlearning oppressive beliefs and actions is a lifelong process, not a single event, and welcomes each learning opportunity • Is willing to take risks, try new behaviors, act in spite of own fear and resistance from other agents

12. Acts against social injustice, believing it is in her/his own self interest to do so • Is committed to taking action against social injustice in own sphere of influence • Is willing to make mistakes, learn from them and try again; willing to be confronted about own behavior/attitudes and consider change • Practices self care

13. Understands the connections among all forms of social injustice • Knows how to cultivate support from other allies • Has the ability to obtain culturally relevant information in the helping relationship • Considers: profession, self, agency, client • Understands that helping and healing are culturally specific activities

14. Some Clinical Considerations: • Physical space • Body language/posture/contact • Sharing the expert role • Tone, cadence, volume/address • Cultural values: family in healing, time, agendas, etiology • Motivation for tx • Use of self disclosure

15. Clinical Considerations • Invasive questions, how helpful clinically? • Use of statements as questions— “help me understand….” • Consider translations, interpretations and contexts • Inclusive language and examples • Use of Jargon • Other historical, cultural & ecological factors

16. Cultural AssessmentAurthur Kleinman, 1978Kleinman A, Eisenburg L, Good B, Culture, Illness, and Care. AIM, 1978;88:251. “Every illness is a personal story” • What do you call the problem? • What do you think has caused the problem? • Why do you think it started when it did? • What do you think your sickness does to you? How does it work? • How severe is your sickness? Will it have a short or a long course? • What are the problems your sickness has caused? • What do you fear the most about your sickness? • What kind of treatment do you think you should receive? What are the most important results you hope to achieve from these treatments?

17. Learning About One’s Own Culture • Historic accounts/Stories • Talk with elders, relatives • Learn history of traditions • Travel • Genealogy • Go to cultural events • Research • Museums • Teach others • Other?

18. Learning About Other’s Cultures • Active listening/Ask • Attending festivals and cultural events • Arts: Music/Reading • Immersion • Food • Travel • Community involvement/volunteer • Exchange students • Other?

19. Ways to Gather Relevant Cultural Information in Clinical Practice • Listen to client: including px, non verbal • Ask relevant questions • Cultural peer review of assessment • Collaboration with other agencies • Research/internet • Don’t assume • Supervision • Continuing ed/trainings • Assess process • Other?

20. Ways to Change Organizational Culture • Education/share knowledge • Speak up • Healthy staff/heal individual wounds • Be passionate • Management training • Advance career • Role modeling • Build trust, team, support • Process improvement • Listen • Rebel • Others?

21. Action Plan: • What action do you want to take to increase cultural competency and/or disrupt racism in your practice and/or organization? • What resources or materials, if any, would you need to achieve your goal? • What behaviors or steps would taking this action entail? • What is a realistic timeline for carrying out the steps involved in this action plan?

22. Action Plan: • What hazards or risks are involved? • What obstacles might you encounter? • What could you do to overcome these obstacles? • What supports do you have? • Where could you find more support? • How could you evaluate your success?

23. Resources: www.nattc.org http://xculture.org/ http://ethnomed.org/ www.tolerance.org http://www.diversityrx.org/

24. Resources/References: • “What Language Does Your Patient Hurt In?,” Salimbene, S. • “A Peoples History of the United States,” Zinn, H., New York: Perennial, 2001. • “Race, Class, and Gender in the United States,” Rothenberg, P. (Ed.), New York: Worth Publishers, 2001. • “Pedagogy of the Oppressed,” Freire, P., New York: Continuum, 2002. • The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and Collision of Two Cultures by Anne Fadiman • “Educating for a Change,” Arnold, Burke, James, Martin, Thomas, Toronto: BTL, 1991. • Film: “The Color of Fear,” Butler, R. Stir Fry Productions • Film: “The Way Home,” Butler, S. Oakland, CA.: World Trust, 2002.

25. Thank You! C. Truth Griffeth, LCSW, CDP, NCAC Native Instincts Consulting Group truth@nativeinstincts.com (206) 399-5846