Cultural Competence in Social Work Emergency Response

Introduction

The evolving concept of cultural competence is an area of reform that is changing the delivery of many aspects of health and social work services. The delivery of social work services — especially during periods of client and family duress — can place a screener or an emergency response social worker in a position requiring rapid response and decision-making regarding the best interests of clients and the state. It is for this reason, and many others, that those who deal with situations requiring rapid and appropriate response must enlist cultural competence not merely as a thought process or a set of ideas, but as an integrated, second-nature pattern of behavior embedded in both the individual and the system.

Cultural competence is essential to the development of social workers and social work systems that are responsive and capable of addressing the results of social and cultural discrimination, poverty, inadequate housing, and more overt forms of inequity. James Green posits that as a profession, social work has several choices regarding how to deal with the issue of desired egalitarianism: "the first choice is that of the pessimist, the second that of the romantic, and the third that of the serious change agent who sees human difference as an opportunity to help and to learn, not as a problem to be overcome" (Green, 1999, p. 5).

In the screening and emergency response social work arena, the call for action has increased in frequency while the diversity of the population served has also grown, creating a situation where the need for cultural competence is pressing. Screeners and emergency response social workers are at the apex of this need, both at the individual and systems level. The ability of an individual and a social work system to appropriately advocate for a client relies, as Green argues, on awareness of diversity and the capacity to act in ways that secure for clients the things they need but have been unable to obtain from the broader community (1999, pp. 24–25).

This paper analyzes the current perception of cultural competence among screeners and emergency response social workers through a quantitative study utilizing a focus group and a questionnaire to elicit pertinent data. The intention is to develop a sense of cultural competency within the system as well as to gather responses regarding individual perceptions of cultural competency and perceived abilities to act upon those standards within their social work settings. This work serves as a baseline assessment of the current state of cultural competency and, it is hoped, a starting point for future research and awareness of need.

Defining Cultural Competence

Cultural competence in health care can be defined in a number of ways, drawing on many dimensions of both "culture" and "competence." The National Association of Social Workers (NASW) produced in 2002 a comprehensive document pertaining to the ethical responsibilities of social workers with regard to cultural competence in the profession. The operational definition of cultural competence, as expressed by NASW, is extensive and broad:

Cultural competence is the integration and transformation of knowledge about individuals and groups of people into specific standards, policies, practices, and attitudes used in appropriate cultural settings to increase the quality of services, thereby producing better outcomes (Davis & Donald, 1997). Competence in cross-cultural functioning means learning new patterns of behavior and effectively applying them in appropriate settings. (NASW, June 23, 2001)

Lastly, to fully define and understand cultural competence, one must recognize that it is not associated only with language awareness, but with a broad understanding of cultural needs and situations that functions for the individual only within a system that is aware of culture as an aspect of necessary social need (Nybell & Gray, 2004, p. 17). The social worker and the system within which he or she works must be genuinely conducive to this goal — not merely aware of it and applying it as dogma (Walker & Staton, 2000, p. 449).

Institutional Requirements for Cultural Competence

The NASW also identifies the institutional and systemic elements that must be in place for a system to be defined as culturally competent. According to NASW, there are five essential elements that work together to support the development and implementation of cultural competence. Each level of competence is gained through ongoing learning, on the part of individuals and of those who together constitute a system (Nybell & Gray, 2004, p. 17):

The system should (1) value diversity, (2) have the capacity for cultural self-assessment, (3) be conscious of the dynamics inherent when cultures interact, (4) institutionalize cultural knowledge, and (5) develop programs and services that reflect an understanding of diversity between and within cultures. These five elements must be manifested in every level of the service delivery system. They should be reflected in attitudes, structures, policies, and services. (NASW, June 23, 2001)

Literature Review: Advocacy, Diversity, and Social Work Practice

As James Green expresses in his work Cultural Awareness in the Human Services: A Multi-Ethnic Approach, the social work field has not always been keenly aware of cultural issues, and has traditionally been populated by, and functioned as an aspect of, dominant-race institutions (Green, 1999, pp. 4–6). For this reason and several others, Green stresses the importance of a shift in both internal and external perception of cultural competence. His focus is on defining cultural competence not through simplified means but through an emphasis on the social worker as an advocate — one who acts as an intermediary between clients and the community in which they live (p. 24). To Green, the idea of ethnic group relations is essential to this goal, as the social worker must be aware of both the opportunities and potential obstacles presented by defined ethnicity, whether defined by self or by others.

Green also stresses that specialization in cultural awareness may be necessary as an accepted standard associated with cultural competency. He emphasizes the need to individualize care and apply resources appropriately in a culturally diverse system — one populated by genuine diversity rather than by a dominant majority with a few token representatives of minority groups (p. 26). Green's perspective is shared by many other social workers and educators who believe that visible representation within a system builds trust and provides valuable knowledge about the needs and desires of the broader community served (pp. 26–28). Trust can also develop when a community observes decisive actions reflecting sensitivity and compassion on the part of even an individual who is not of the same background, but who demonstrates genuine awareness that transcends presumed differences (pp. 26–28).

Green stresses that the persistence of social discrimination is both overt and subtle, and that language — while significant — is only one part of it (pp. 10–12). He argues that the nature of meaningful change is empowerment: communities defined by diversity and internal cohesion must be able to articulate their own needs and wants, and the social worker is positioned to amplify that voice in support of community-driven change (p. 6). One means through which Green proposes such advocacy can occur is a more applied and nuanced definition of multiculturalism.

Walker & Staton provide a useful account of the problems and dimensions of cultural competency in social work:

The current representation of multiculturalism as a knowledge area and type of social worker competence is inaccurate, and subject to promoting unintended stereotyping. Further, it is unclear whether or not licensing boards can accurately measure skill in this area. It has become more of a creed to which social workers feel compelled to adhere than a body of knowledge that informs practice. The logical positioning of the idea is as an ethical principle regarding virtuous social work practice. The principle embraces understanding a client's behavior, thinking, and feeling in the full context of the sociocultural, religious, ethnic, and economic life within which all of these arise (Comas-Diaz, 1996; Green, 1995). Empathy, respect, and appreciation for the client are the ultimate expressions of whatever might be intended by the notion of multiculturalism. Traditional biomedical ethics perhaps captures the concept of cultural sensitivity more generally, but more effectively, in the principle of respect for autonomy (Beauchamp & Childress, 1994). By this account, respect for autonomy means respectful actions, not just an attitude of acceptance. (Walker & Staton, 2000, p. 449)

Conclusion and Research Direction

The defining character of complete cultural competence, according to most experts, has yet to be fully met or defined, though Green is tremendously successful in attempting to do so. It is therefore necessary to understand the current state of social work practice with regard to cultural competency — and specifically with regard to rapid response social workers such as those found within screening and emergency social work systems. This analysis is intended to serve as a litmus test for the current state of cultural competency and as a starting point for future research and awareness of need.

References

Galambos, C. M. (2003). Moving cultural diversity toward cultural competence in health care. Health and Social Work, 28(1), 3.

Green, J. (1999). Cultural awareness in human services: A multi-ethnic approach (3rd ed.). Allyn and Bacon.

National Association of Social Workers. (2001). NASW standards for cultural competence in social work practice. Author.

Nybell, L. M., & Gray, S. S. (2004). Race, place, space: Meanings of cultural competence in three child welfare agencies. Social Work, 49(1), 17.

Walker, R., & Staton, M. (2000). Multiculturalism in social work ethics. Journal of Social Work Education, 36(3), 449.