Culturally competent practice models: strengths and shortcomings
A number of approaches to culturally responsive practice have developed over time. Grounded in a modernist paradigm, the cultural literacy model was the first broadly applied framework (Dyche & Zayas, 1995). Based on the assumption that culture is knowable, this approach emphasized learning about the shared history, traits, and practices of particular cultural groups and applying culturally specific interventions. Rooted in anthropology and ethnography, the cultural literacy model fit with early definitions of culture
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as a static and monolithic construct, thus neglecting the degree of accultura- tion and sociocultural realities of multiple intersecting identities. It has been criticized for its impracticality, reductionist approach, attention to the abstract over the experiential, and potential for overgeneralization and stereotyping (Ben-Ari & Strier, 2010; Dyche & Zayas, 1995; Tsang & Bogo, 1997). The notion that one can truly know another’s culture or be an expert in the cultures (and subcultures) of others has been challenged as unrealistic and simplistic (Dean, 2001). Furthermore, a cornerstone of early approaches to cultural competence was a celebration of differences relating to distinct cultural histories and traditions. There were, and continue to be, good reasons to celebrate differences; however, this lens can inherently obscure other critical dimensions of experience such as racism and discrimination.
Social work has historically adopted either a cultural deficit approach or a cultural relativist approach to practice, both of which can be problematic (Barn, 2007; Chand, 2008). A deficit perspective is criticized for pathologiz- ing cultural beliefs and practices perceived as deficient, resulting in interven- tions that are overly intrusive or unnecessarily interventionist. A relativistic perspective, on the other hand, is criticized for viewing all cultural practices, including those that are potentially harmful, as equally valid, resulting in interventions that are too weak or hesitant. The challenge comes in striking a fair balance between the two ends of the spectrum. Healy (2007) suggests that social workers are likely to find a midpoint that may shift in one direction or the other depending on client circumstances; however, cultural relativity should never be used as a rationale for violating human rights.
Although several cultural competence frameworks have been proposed in social work practice and academia, no consensus appears to have been reached in the profession thus far. In their synthesis of the cultural compe- tence literature, Kohli and colleagues (2010) conclude that most approaches share some basic assumptions, including the premise that reality is socially constructed, diverse worldviews must be appreciated, multiple realities shape individual personalities, and diversity education has a positive effect on developing cultural competencies. Este (2007) also highlights several key themes emerging from the literature describing the building blocks for culturally competent social work practice, including a specific knowledge base about diversity and oppression, a lifelong process of learning about the worldviews of cultural groups, strong communication skills, a capacity for empathy, and a congruent intrinsic value base.
Informed by a postmodern frame, Sue, Ivey, and Pedersen’s (1996) theory of multicultural counseling and therapy is possibly one of the most influen- tial frameworks for delineating the development of cultural competence in the helping professions. This approach views cultural competence as an active and ongoing process and proposes a 3-by-3 matrix consisting of three characteristics of cross-cultural competencies: (a) counselor’s awareness
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of his or her own assumptions, values, and biases, (b) counselor’s awareness of the client’s worldview, and (c) culturally appropriate interventions—all of which develop across three dimensions: (a) knowledge, (b) beliefs and atti- tudes, and (c) skills. An understanding of macro-systemic factors was more strongly incorporated in later versions of the framework (Sue & Sue, 2013). A major limitation of this theory, however, is its culture-specific focus as opposed to a broader worldview. Nevertheless, the core dimensions of knowledge, awareness, and skills are foundational to most frameworks and standards for culturally attuned practice (Jackson & Samuels, 2011; National Association of Social Workers [NASW], 2001, 2007).
In social work, cultural competence models are increasingly informed by social-ecological theory and target micro-, mezzo-, and macro-level actions and results (Simmons, Diaz, Jackson, & Takahashi, 2008). With their added emphasis on the impact of social injustices and oppressive power relations and the goal of social change through multilevel practice, some of the cultural competence models proposed in the social work literature have addressed the shortcomings of psychologically oriented frameworks. For instance, George and Tsang (1999) examine the social construction of diversity and address the intersectionality of oppressions in their social constructionist approach to cultural competence; Laird (2008) and Sakamoto (2007a, 2007b) advocate for the infusion of anti-oppressive principles into culturally competent practice models; and Saleebey (2012) focuses on client strengths rather than problems with the goal of promoting empowerment. Fong (2004) integrates each of these elements in her contextual approach to culturally competent social work practice using an ecological framework. The person-in-environment focus of ecological theories, the cornerstone of social work practice, encom- passes both individual and environmental factors when assessing problems and finding solutions with clients from diverse backgrounds (Haynes & Singh, 1992). Moreover, the values and ethics underpinning social work practice have been recognized as providing a foundation for understanding and appreciating culture and diversity (Hugman, 2013).
Addressing the power imbalances that shape worker-client dynamics, the construct of cultural humility has emerged as an alternative conceptualiza- tion of cultural competence that underscores authenticity, respect, and hum- bleness in helping relationships. Fisher-Borne, Cain, and Martin (2015) describe the core interconnected elements of cultural humility as institutional and individual accountability, life-long learning and critical reflection, and mitigation of power differentials. Characterized by an “other-oriented” inter- personal stance, cultural humility has been shown to be positively correlated with a strong working alliance and improvements in therapy (Hook, Davis, Owen, Worthington, & Utsey, 2013).