A core foundation of social work training includes education on inclusion and diversity. As a clinical social worker, I provided direct patient care to individuals from many different cultures and backgrounds. As a woman working in the legal and corporate field, I certainly have experienced disparity in the workplace. Having had these experiences, I can better appreciate other cultures and backgrounds and recognize the importance of listening and appreciating others’ views and experiences, as they are not my own. As an Allied Healthcare Professional (AHP), it is important to listen, educate yourself, and gain an understanding that will allow effective interactions with people of all cultures and backgrounds.
All AHPs, at some point in their careers, will encounter patients of differing backgrounds, and it is critical to ensure that all patients are treated equally. There are many issues occurring in society, on top of dealing with a global pandemic, COVID-19. Your patients may be upset, frustrated, or even angry. It is important to address increased concerns that may be raised by patients, given all that society is experiencing: racial injustices and the Black Lives Matter movement, changes in legal protections impacting the LGBTQ community, and other issues of inequality. So, how do we accomplish this?
It is not an easy or straightforward answer. In any Allied Healthcare profession, it is of the utmost importance to engage in education and training to advance and promote cultural competence. A 2008 study found that only 37% of allied healthcare programs in California offered education on cultural competency or patient communication.[1] It is hopeful that, if this study were conducted today, the statistic would be a stronger number.
What is cultural competence? Again, this is not a straightforward answer, and many definitions have been developed. The definition of cultural competence emerged with the work of Cross in 1989 which indicated: “cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency or among professionals and enable that system, agency or those professions to work effectively in cross-cultural situations.”[2] There are five essential elements which contribute to an institution's ability to become more culturally competent:
- Valuing diversity;
- Having the capacity for cultural self-assessment;
- Being conscious of the dynamics when cultures interact;
- Having institutionalized cultural knowledge; and
- Developing adaptations to service delivery reflecting an understanding of cultural diversity[3]
If working in a rural area without much diversity, you may not experience a wide range of backgrounds and cultures; however, if you work in an urban area, it is likely you will encounter a diverse population. Whether you work in a rural setting or urban setting, it is critical that you obtain and maintain cultural competence to effectively treat all patients. It is essential to treat all patients equally no matter their ethnicity, cultural background, sexual orientation, gender, religious affiliation, or social class.
Listen and learn from your patients as there are many factors which influence individual beliefs. In fact, if you are not part of the community, consider listening more and speaking less. There may be many differences and variations in how individuals perceive themselves, even if you are from the same background. It is important not to stereotype by assuming that all people from the same background have the same beliefs. Make sure you educate yourself; consider taking an online course, training, or review articles on cultural competence. Open your professional and personal circle, if you have not already, to include people of different backgrounds. Experience is often the best teacher.
If treating patients who have behavioral health issues, keep in mind that some cultures may not be accepting of persons with mental illness or persons seeking treatment for mental illness. As a result, those with mental illness may seek care less often, and resources also may be limited within certain cultural groups due to language barriers and other factors. For example, Asian-Americans are three times less likely to seek behavioral health treatment than other Americans.[4] Remain cognizant of how behavioral health may be viewed generally in a culture and to a person/family in a culture. Seek additional information and resources to obtain the necessary education to effectively and adequately treat the patient.
Ensure you review resources and obtain guidance on how to best address your patients’ needs. You are not expected to know everything about every culture or background. It is, however, important to provide competent care for all patients.
Check your professional organization for resources or statements on its website. Below are some helpful links from several AHP organizations:
Although not an exhaustive list, here are some additional resources on culture, diversity, training, and education you may find helpful. There are many other resources out there which can be accessed online, and through universities/colleges, but this was compiled to assist in obtaining additional cultural information:
- Anxiety and Depression Association of America- Asian Americans: https://adaa.org/asian-americans - Provides statistics, information and resources concerning behavioral health issues impacting Asian Americans
- Black Mental Health Alliance: www.blackmentalhealth.com – Develops, promotes, and sponsors culturally-relevant educational forums, trainings, and referral services that support the health and well-being of Black people and other vulnerable communities
- Diversity Inc: www.diversityinc.com/ – Discussion concerning diversity issues addressed from a corporate viewpoint
- National Asian American Pacific Islander Mental Health Association: www.naapimha.org – Raises awareness of the role of mental health in an individual’s health and well-being, particularly in Asian American Pacific Islander communities throughout the country
- National Center for Cultural Competence: https://nccc.georgetown.edu/ – Provides national leadership and contributes to the body of knowledge on cultural and linguistic competency within systems and organizations. A major emphasis is placed on translating evidence into policy and practice for programs and personnel concerned with health and mental health care delivery, administration, education, and advocacy. Provides training, publications, and products to identify and share best practice standards
- National Congress of American Indians: www.ncai.org – Works to inform the public and Congress about governmental rights of Native Americans and Alaska Natives
- National Latino Behavioral Health Association: www.nlbha.org – Provides advocacy, research, and policy to reduce disparity in mental health in the Latino population
- National Alliance on Mental Illness: www.nami.org – Provides advocacy, peer support, publications, and legislative action
- National Organization for People of Color Against Suicide: www.nopcas.org – Provides information on suicide prevention and intervention specifically for people of color
- SAIGE (Society for Sexual, Affectional, Intersex, and Gender Expansive Identities): https://saigecounseling.org/ - Advocacy, publications, webinars, and online education
- SAMHSA (Substance Abuse and Mental Health Services Administration)- Resources on Cultural Competency: https://www.samhsa.gov/section-223/cultural-competency/resources - A comprehensive program to access resources and online training on cultural competency from SAMHSA and other agencies and organizations. SAMHSA is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance behavioral health in the United States. The mission is to reduce the impact of substance use and mental illness on America's communities
- World Health Organization: www.who.int/en – Directs and coordinates international health within the United Nations system. Their main areas of work include: health systems; health through the life-course; noncommunicable and communicable diseases; preparedness, surveillance and response; and corporate services.
[1] Chapman, S., Bates, T., O’Neil, E., Chan, M., UCSF Center for the Health Professions Fred Donini-Lenhoff, American Medical Association, “Teaching Cultural Competence in Allied Health Professions in California,” The Center for Health Professions, University of California, San Francisco, Feb. 2008
[2] Georgetown University Center for Child and Human Development, National Center of Cultural Competence, “Definition of Cultural Competence,” citing Cross, T., Bazron, B., Dennis, K., & Isaacs, M., (1989), “Towards A Culturally Competent System of Care,” Georgetown University Child Development Center, CASSP Technical Assistance Center, https://nccc.georgetown.edu/curricula/culturalcompetence.html, [last accessed June 22, 2020]
[3] Ibid.
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Kristen Lambert, JD, MSW, LICSW, CPHRM, FASHRM
Healthcare Practice and Risk Management Innovation Officer
Trust Risk Management Services, Inc.
email: contact@trustrms.com
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