critical model for working across differences in social work practice
Integrating cultural competence and social work practice in a coherent and clinically grounded way poses a continuing challenge in the field and conse- quently, a gap in the literature (Lee, 2010). While there appears to be some consensus regarding the broad constructs of what constitutes cultural com- petence, specific practice components have not been firmly established. Thus, building upon the strengths and mitigating the implicit and explicit short- comings identified in the literature, we propose an integrated conceptual framework for culturally responsive social work practice.
Cultural competence has been defined in various ways, but at its core is the ability to work effectively across differences. Given that individuals interpret their world in complex and ultimately unique ways, we argue that social workers are always working across differences, regardless of the extent to which they share a common cultural heritage or social location with their clients. Recognition of this fundamental reality of practice is reflected in the proposed model. Given the power of language in shaping social work dis- course, we have replaced the term competence with the construct of con- sciousness. We agree with others (e.g., Dean, 2001) that one can never unequivocally achieve competence simply through the acquisition of cultural knowledge and skills. That being said, maintaining a continuous, mindful awareness of culture and diversity, including the complex ways in which they construct meaning and experience, promotes effective and ethical practice. We view cultural consciousness, therefore, as an ongoing and dynamic developmental process with no endpoint—one that requires active, critical, and purposeful engagement on the part of the social worker entering the helping relationship.
Our framework offers an integrated and multilevel approach to culturally conscious practice and advances knowledge by addressing the limitations of existing conceptual models in several important ways. First, it is grounded in a strong epistemological and theoretical foundation. Second, it adopts a multidimensional view of culture that extends beyond race and ethnicity to include multiple, intersecting, and shifting identities, thereby not limiting its utility to visible minorities. Third, it offers analyses of asymmetrical power relations contributing to cultural alterity. Fourth, it can be infused into multilevel social work practice across micro, mezzo, and macro concentra- tions. Fifth, the model identifies specific clinical skills and provides a con- ceptual framework focusing on cognitive and affective domains that can be applied to generalist social work practice. Sixth, it can be widely and effec- tively utilized by social workers from both minority and dominant cultures working with clients from both minority and dominant cultures. And finally, cultural consciousness is conceptualized not only at the level of the individual
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social worker, but also at the broader level of the organization, recognizing that systemic support is crucial to delivering culturally responsive services.
With knowledge, skills, and attitudes as overarching dimensions, the core components of the proposed model of critical cultural consciousness in social work are delineated across four fundamental domains: (a) evidence-based knowledge, (b) conceptual framework for practice, (c) intervention strategies, and (d) critical self-awareness. Although each element is discussed next in a sequential manner, together they provide context for one another and inter- act in reciprocal ways.
Evidence-based knowledge
Specialized knowledge in a variety of substantive domains supports an evidence-based approach to working competently across differences and fosters critical thinking. The knowledge relevant to informing practice will vary depending on the unique cultural background, social locations, and situational context of each diverse individual. While reliance on “knowing” culture has been critiqued as reductive and promoting stereotyped assess- ments, we argue that evidence-based knowledge about culture and diversity can be a valuable component of social work practice, when applied appro- priately. Knowledge generated through quantitative and qualitative research, including community- and arts-based designs for example, is ideally suited to inform practice. Opportunities to critique methodological rigor, potential sources of Eurocentric bias, and knowledge claims can remedy some of the implicit tensions between cultural competence and evidence-based approaches, which sometimes privilege certain “ways of knowing” over others (Kirmayer, 2012).
The experiences of individuals, however, are unlikely to mirror exactly the collective experience of groups. For this reason, empirical knowledge must be considered tentative and neither generalizable nor transferable in its applica- tion at the level of a unique individual, family, or group. Consistent with Laird’s (1998) concept of “informed not-knowing,” knowledge should be approached with an open mind, while maintaining a capacity to suspend such knowledge to mitigate against stereotypes and false assumptions. To this end, group-based knowledge can be helpful to sensitize social workers to potential cultural practices and experiences of individuals without essentia- lizing them. This is a subtle yet important distinction. An attitude of “respectful curiosity” (Dyche & Zayas, 1995) augments simultaneous efforts to understand unique variations through a process of empathic confirmation and learning from individual clients, who are the real experts about their lives.
We highlight three broad knowledge domains next, which we purport to be key elements of evidence-based cultural consciousness in social work.
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Discrimination and inequality as social injustices The supposed problem with difference, as pointed out by Cooke (1999), is that some people are discriminated against simply because they are different from the majority or dominant culture. As human beings, we seem to have an infinite capacity to dichotomize others as “us” or “them” depending on how we perceive their similarities or differences. Consequently, an indivi- dual’s experiences and opportunities in life are shaped by the manner in which he or she is potentially subordinated (or privileged) in society based on dimensions of diverse identities. Those who are regarded as different from dominant groups according to socially prescribed power hierarchies are more likely to experience discrimination and adverse outcomes (Wilkinson & Pickett, 2009). This is the profound reality that transforms the issue of being different into one of potential social injustice and thus constitutes essential knowledge for practice.
Evidence-based knowledge from around the world has shown that inequality has reached a critical point. The size of the gap between the rich and the poor has been consistently correlated with virtually any health, socioeconomic, or social outcome (Wilkinson & Pickett, 2009). For example, evidence suggests that socially marginalized groups experience multiple forms of interpersonal and systemic discrimination in health care, which impede access to health services and result in greater health disparities (Betancourt, Green, Carrillo, & Ananeh-Firempong, 2003; Mikkonen & Raphael, 2010; Raphael, 2009).
History, colonialism, and neoliberal ideology Working with others takes place within a particular historical, social, poli- tical, and economic context. In Western societies, the past three decades have witnessed a vast expansion in cultural diversity. Knowledge about specific cultures is an important starting point for cultivating cultural sensitivity and insight into the social realities of diverse groups. For instance, group-based historical knowledge about the devastating impact of colonialism on Indigenous populations can raise awareness of potential issues manifesting at the personal level but originating at the societal level. Knowledge of the multifaceted ways in which power-based oppression, marginalization, and systemic discrimination can affect health, well-being, and service delivery is an essential component of critical social work practice with diverse populations.
The broader context of capitalism, globalization, and neoliberalism emphasizes individual (over social) responsibility and shrouds the structural obstacles that disproportionately impact diverse individuals and groups (Coburn, 2010). The global shift toward smaller government, deregulation, lower taxes, laissez-faire capitalism, and the consequent degradation of social welfare programs and services contributes to personal hardships. While
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social and economic policies shaped by neoliberal ideology impact all indi- viduals to some extent, diverse populations such as racialized minorities, new immigrants, and those living in poverty are often more severely affected. This knowledge is inherently political and can inform advocacy efforts for broader social change.
Postmodernism, multiple identities, and intersectionalities A postmodernist paradigm recognizes the continuously changing nature of experience and embraces multiple personal and contextual realities, unique narratives, and subjective interpretations. With an appreciation for multiple truths and sources of knowledge, a postmodern perspective views all cultural beliefs, practices, and worldviews as valid. Individuals may identify with a variety of diverse characteristics and social locations that contribute to them being perceived as different, thereby increasing their risk for various forms of discrimination. The concept of intersectionality is used to capture this com- plex interplay among multiple identities and sites of possible oppression (and privilege).
A postmodern orientation promotes a conceptual shift from situating the social worker as expert, embraces uncertainty, and places emphasis on learning with and from the client. Representing and speaking for the “other” can be hazardous given the (unintentional) potential for harm and disempowerment. To reflect the relational focus and dynamics of clinical social work practice, Lee (2010) envisions cross-cultural competencies as fluid processes that vary over time with each unique individual. This revi- sioning expands the construct of cross-cultural work beyond a static char- acteristic of the social work clinician to encompass the dynamic interactions between dyads within a therapeutic relationship; in other words, from a one- person psychology to a two-person psychology. This interpersonal process is both iterative and reciprocal, reflecting their shared history and interaction. Highlighting the challenges involved in maintaining positive engagement and responsiveness in therapeutic dialogue across cultures, Lee and Horvath’s (2014) work illustrates the importance of focusing on moment-to-moment interactions in cross-cultural clinical practice.
Conceptual framework for practice
In addition to the empirical knowledge domains just described, working effectively across differences requires a broad yet clearly articulated concep- tual framework to integrate components of practice. As social workers, we function in positions of power and are “brokers of reality” (McNeill, 2006); that is, we are in privileged positions to make judgments about the behaviors and actions of our clients. The lenses through which we understand the experiences of others are of central importance. For example, if we are
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oriented solely to a personal growth approach, we may perceive clients as struggling with lifestyle choices, in which case we are likely to formulate the presenting issues as “private troubles” with a corresponding clinical goal of facilitating more individual responsibility. This approach may obscure the broader structural forces at play within the social environment that operate to marginalize and oppress. Alternatively, if we identify exclusively with a structural approach, we may overlook important personal variables while concentrating on societal power imbalances beyond the control of the individual.
Although it is not feasible to explore the full range of theories and conceptual models that may contribute to an overall framework for culturally competent practice, we highlight key complementary approaches that may be particularly helpful in bridging the cultural divide in social work practice.
Ecological and strengths-based orientations Ecological systems theory, with its emphasis on the reciprocal interplay of factors across micro, mezzo, and macro systems, provides an ideal framework for integrating important considerations at multiple levels of the social ecology (Bronfrenbrenner, 1979). At the micro level, attention is drawn to the emotions, behaviors, cognitions, attributions, and relationships that shape and reflect individual experience, and may be suitable targets for clinical interventions to promote personal agency, self-efficacy, and psycho- logical welfare. By contrast, macro-level analysis provides a means of identi- fying powerful structural forces that impact individuals such as the broad social determinants of health (e.g., toxic effects of poverty and social exclu- sion on health and well-being), combined with restricted availability of social welfare programs consequent to neoliberal restructuring. Recognizing the reciprocity of factors across ecological systems contributes to a broader understanding and scope of practice to address multilevel problems.
A strengths-based orientation is an important component of social work practice with clients from diverse communities who experience personal blame for the challenges they face (Larson, 2008; Saleebey, 2012). A strengths perspective guards against pathologizing individuals by shifting attention from deficits to assets. Moreover, a resilience model that identifies both risk and protective factors at all levels of social ecology complements a strengths-based approach while simultaneously validating the obstacles at play. Areas of risk and resilience are understood as subject to interpretation. Attributed meanings are personally and socially constructed and are part of the bedrock of human experience (Wakefield, 1995).
Critical approaches Critical theories such as feminism and political economy offer additional necessary frameworks for understanding diversity, oppression, and aspects of
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experience within a social context. Critical approaches to practice help to expose sociocultural and political processes that reinforce embedded power asymmetries that shape the lived experiences, social exclusion, and material deprivation of marginalized groups.
Together, these complementary approaches comprise components of a conceptual framework that recognizes individual qualities as well as environ- mental factors that are the source of many hardships affecting diverse individuals and communities. It is not our intent to be prescriptive about specific approaches but to identify the importance of including a critical lens as part of a multi-theoretical framework.
Intervention strategies
Through the integration of evidence-based knowledge and an overall con- ceptual framework that promotes the use of various lenses for understanding a client’s circumstances, social workers can apply a range of culturally responsive intervention strategies, including anti-oppressive practices at clin- ical, community, and policy levels. It is beyond the scope of this article to provide a full account of all potentially relevant interventions. Nonetheless, we propose the following as complementary dimensions of social work practice that are helpful in working effectively across differences.
Individualize through clinical empathy On a clinical level, a capacity for empathy is essential to maximize our understanding of others in a way that resonates both intellectually and emotionally. Cultural empathy requires a clinician to understand and be responsive to the experiences of diverse clients based on their interpretation of cultural data, as well as affective and communicative processes (Ridley & Lingle, 1996). It is a “general skill or attitude that bridges the cultural gap between the therapist and client, one that seeks to help therapists to integrate an attitude of openness with the necessary knowledge and skill to work successfully across cultures” (Dyche & Zayas, 2001, p. 246). In her study examining variables contributing to multicultural competence, Constantine (2001) found that clinicians who endorse higher cognitive and affective empathy, along with higher levels of multicultural training and an eclectic theoretical orientation, have better multicultural case conceptualization skills. The importance of empathy and compassion in culturally competent social work services was echoed by members of a range of oppressed groups (Gentlewarrior, Martin-Jearld, Skok, & Sweetser, 2008).
An empathic understanding is instrumental in facilitating cross-cultural engagement, trust, and ontological integrity by increasing the likelihood that the intersubjective co-construction of meaning and experience approximates the “truth” for clients. An empathic understanding therefore individualizes
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clients; that is, it differentiates them from others and reflects their unique aspects of identity, experience, degree of acculturation, and shared experience with other members of the community. As such, it is part of a differential approach to enable a formulation that ensures micro-level interventions are targeted effectively. An empathic understanding of client strengths contri- butes to fostering empowerment through efforts to increase personal agency and self-efficacy to maximize an individual’s internal locus of control.
Deindividualize for anti-oppressive interventions A complementary process of deindividualization is also needed to promote an overall formulation that includes consideration of broader structural forces, thus ensuring that the helping relationship is not limited to a singular focus on personal struggles and individual responsibility. For this reason, an anti- oppressive perspective and culturally conscious practice go hand-in-hand (Ben- Ari & Strier, 2010; Laird, 2008; Parrott, 2009; Sakamoto, 2007a, 2007b). Anti- oppressive principles support a sociopolitical analysis of oppressive power dynamics that often underlie the problems faced by diverse groups and help to expose the Eurocentric knowledge base upon which most social work interven- tions are grounded (Sakamoto & Pitner, 2005). Through the process of deindi- vidualization and contextualization, an anti-oppressive approach helps to identify problems within their broader social context with the goal of transform- ing the power imbalances that perpetuate marginalization and various manifes- tations of discrimination. Thus, cultural consciousness, informed by anti- oppressive practice, incorporates a strong commitment to social justice.
On an individual level, examples of anti-oppressive practice designed to complement clinical-level interventions include the use of a strengths-based approach, efforts to connect clients to necessary resources, and individual advo- cacy to gain access to services and navigate the system. Beyond work at themicro level, efforts to partner with community-based organizations to plan for com- munity development and advocate for changes regarding program availability and policy reform are valuable strategies for addressing social context. Broad- based systemic advocacy (i.e., efforts to ameliorate the unequal power relations and social conditions adversely affecting whole communities) has the potential advantage of mobilizing a coalition of forces to bring about social change.
Agency and institutional context The internal policies and service delivery standards of institutional settings can systemically promote or impede cultural consciousness. Nybell and Gray (2004) call attention to the need for “agencies to undertake an organizational development process that parallels the individual journey of the worker toward cultural competence” (p. 18). This journey begins with organizations embracing cultural consciousness as a strategic priority and entrenching its values across all aspects of its operation, from mission statement to frontline