This interactive National Social Work Ebook contains 15 hours of continuing education. To complete click the Complete Your CE button at the top right of the screen.
Social Work Continuing Education
Elite Learning
Want Elite Learning’s best offer? See inside front cover.
ELITELEARNING.COM/BOOK Complete this book online with book code: SWUS1525 15-Hour Continuing Education Package $75.00
What’s Inside Chapter 1: Cultural Humility in Behavioral Health [3 CE Hours]
1
The purpose of this education program is to present an introduction to cultural humility and offers tools for psychologists and other behavioral healthcare professionals to use when working with patients from diverse backgrounds in a culturally humble manner. Chapter 2: Ethics in Behavioral Health Documentation: Reasons, Risks, and Rewards [3 CE Hours] This basic-level course will help practitioners approach documentation in a way that is guided not solely by what is mandated, but by what is mutually beneficial to all stakeholders in the documentation process: The practitioner, the agency, the funding source, and – most of all – the clients. Chapter 3: Managing Professional Boundaries
23
48
[3 CE Hours] This course is intended for healthcare professionals who provide care to clients/patients. The course discusses professional standards and principles for providing safe ethical care, how those standards are reflected in clinical boundaries, common boundary dilemmas faced by clinicians, and how to apply a decision-making model to navigate boundary situations. Chapter 4: Suicide Risk in Adults: Assessment and Intervention, 2nd Edition [3 CE Hours] 69 The purpose of this course is to assist clinicians in understanding factors that contribute to suicidal behavior, conducting comprehensive suicide risk assessments, and engaging patients in brief, empirically-supported interventions to reduce risk of death. This course meets an increasing demand of many mental health professionals seeking information about working with suicidal clients and conducting empirically-supported suicide risk assessments. Chapter 5: Adolescent Substance Use Disorders for Healthcare Professionals, 2nd edition [1 CE Hour] 94 Description of current state: The key risk periods for substance use disorders (SUD) occur during life transitions, such as adolescence. This means that substance use assessment and intervention is especially critical for the adolescent population. The emphasis for this basic-level course is on helping healthcare professionals to effectively assess adolescents for substance use disorders and intervene effectively with adolescents who are dealing with such disorders. Chapter 6: Alzheimer’s Disease and Other Dementias: Symptoms, Stages, and Communication Strategies Expanded [2 CE Hours] 108 Alzheimer’s disease is one of the leading illnesses affecting the elderly and is the most prevalent of the dementias. As people are living longer, the number of Americans diagnosed with AD is expected to reach 82 million by 2030, according to the World Health Organization (Zhou et al 2022). Learning about AD’s brain impact, stages and their respective symptoms, patient responsiveness, and caregiver burden will enable you to align with colleagues to share information that will impact lives. This course will provide insight and understanding based on the most current data to enable you to have deeper insight into the impact of AD.
©2024: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge in the areas covered. It is not meant to provide medical, legal or professional services advice. Colibri Healthcare, LLC recommends that you consult a medical, legal or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation or circumstances and assumes no liability from reliance on these materials. SOCIAL WORK CONTINUING EDUCATION Book Code: SWUS1525 i
Frequently Asked Questions
What are the requirements for license renewal? License Expires
Hours and Mandatory Subjects
Varies depending on state.
See state requirement chart on the following pages.
How much will it cost?
CE HOURS PRICE COURSE CODE
COURSE TITLE
Chapter 1: Cultural Humility in Behavioral Health
3
$27.00 SWUS03BH
Ethics in Behavioral Health Documentation: Reasons, Risks, and Rewards
Chapter 2:
3
$27.00 SWUS03ET
Chapter 3: Managing Professional Boundaries
3
$27.00 SWUS03PB
Chapter 4: Suicide Risk in Adults: Assessment and Intervention, 2nd Edition
3
$27.00 SWUS03SR
Adolescent Substance Use Disorders for Healthcare Professionals, 2nd edition Alzheimer’s Disease and Other Dementias: Symptoms, Stages, and Communication Strategies Expanded
Chapter 5:
1
$9.00 SWUS01AD
Chapter 6:
2
$18.00 SWUS02AL
Best Value - Save $60.00 - All 15 Hours
15 $75.00 SWUS1525
How do I complete this course and receive my certificate of completion? See page v for step-by-step instructions to complete and receive your certificate. Are you an approved provider?
Colibri Healthcare, LLC (formerly Elite Professional Education, LLC), Provider Number 1147, is approved as an ACE provider to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Regulatory boards are the final authority on courses accepted for continuing education credit. ACE provider approval period: 5/5/2023 – 5/5/2026. Social workers completing this course receive 15 total credits including 7 clinical, 3 cultural competence, 3 ethics, and 2 general continuing education credits. Illinois Department of Financial and Professional Regulation (Social Work Sponsor #159.001485). Florida Board of Social Workers, and Ohio Counselor, Social Worker And Marriage And Family Therapist Board – (Provider #50-4007), New York State Education Department Continuing Education Provider #SW-0004. Important information for licensees: Always check your state’s board website to determine the number of hours required for renewal, mandatory topics (as these are subject to change), and the amount that may be completed through home-study. Also, make sure that you notify the board of any changes of address. It is important that your most current address is on file. Is my information secure? Yes! We use SSL encryption, and we never share your information with third-parties. We are also rated A+ by the National Better Business Bureau. What if I still have questions? What are your business hours? No problem, we have several options for you to choose from! Online at EliteLearning.com/Social Work you will see our robust FAQ section that answers many of your questions, simply click FAQs at the top of the page, e-mail us at office@elitelearning.com, or call us toll free at 1-866-653-2119, Monday - Friday 9:00 am - 6:00 pm, Saturday 10:00 am - 4:00 pm EST.
ii
Book Code: SWUS1525
SOCIAL WORK CONTINUING EDUCATION
How Many Continuing Education Hours do I Need? NOTE: CE Rules can change. Always check your state board for the most up-to-date information.
HOURS ALLOWED BY HOME-STUDY
HOURS REQUIRED
STATE
MANDATORY
Alabama
30 45
20 45
3 hours in ethics; 3 hours in clinical (if licensee has a clinical designation). 6 hours in substance abuse education; 6 hours in cross-cultural education, of which three hours include issues relating to Alaska Natives; 3 hours in professional ethics; 3 hours in teletherapy practice; 3 hours in suicide education. 3 hours in behavioral health ethics or mental health law; 3 hours in cultural competency and diversity; 3 hours of Arizona Statutes/Regulations Tutorial on the Board website.
Alaska
Arizona
30
30
Arkansas California
30 36
15 36
3 hours of ethics.
6 hours of laws and ethics (every renewal); 7 hours of HIV/AIDS (first renewal only); 6 hours suicide risk assessment and intervention (one-time requirement); and 3 hours in telehealth (one-time requirement).
Colorado
40 15
40 10
None.
Connecticut
1 hour on cultural competency; 2 hours mental health conditions common to veterans and family members of veterans, including (1) determining whether a patient is a veteran or family member of a veteran, (2) screening for conditions such as post- traumatic stress disorder, risk of suicide, depression and grief, and (3) suicide prevention training (first renewal and once every six years thereafter).
Delaware District of Columbia
40 40
40 12
6 hours in ethics, 1 hour in mandatory reporting.
6 hours in ethics (must be done face-to-face, no online courses accepted); 2 hours in LGBTQ; 4 hours in relevant topics designated as D.C. Health Public Health Priorities. 2 hours Preventing Medical Errors in Behavioral Health (each renewal); 3 hours Ethics & Boundaries in Psychotherapy - or - 3 hours Teletherapy (each renewal); 2 hours Domestic Violence (required every third renewal); 3 hours Florida Laws and Rules (required every third renewal); Supervisors: 4 hours Qualified Supervision Training (every third renewal). 5 hours of ethics relating to professional counseling, social work, marriage or family therapy (must be in an interactive format: live or synchronous). 15 hours have to relate to specialty/profession.
Florida
30
30
Georgia
35
10
Idaho Illinois
20 30
20 30
1 hour of ethics.
3 hours of ethics; 3 hours of cultural competency; 1 hour of sexual harassment prevention, 1 hour of implicit bias; 1 hour in Alzheimer disease and other dementias (if licensee provides health care services to patients 26 years of age and older); 1 hour of DCFS Mandated Reporter Training, within 3 months of initial licensure and at least every 3 years thereafter.
Indiana
40
40
At least 20 hours of Category I Continuing Education and 2 hours of Category I Ethics Continuing Education.
Iowa
27 40 30
27 40 30
3 hours in ethics.
Kansas
3 hours in ethics; 6 hours related to the diagnosis and treatment of mental disorders. 3 hours of board-approved Kentucky Code of Ethical Conduct; 6 hours of suicide assessment, treatment and management (every six years); 3 hours in domestic violence and elder abuse; 1.5 hours in pediatric abusive head trauma (every six years) 3 hour supervision course for supervisors. 3 hours in ethics; 10 hours in diagnosis and treatment (LCSW); 3 hours in clinical supervision if designated a supervisor. 4 hours in ethics (6 hours for conditional licensees); 12 hours in family and intimate partner violence (one time requirement). 3 hours in ethics and professional conduct, including boundary issues, or pertaining to the standards of practice and laws governing the profession of social work in Maryland; 3 hours in supervision if a supervisor.
Kentucky
Louisiana
20
10
Maine
25
10
Maryland
40
20
iii
SOCIAL WORK CONTINUING EDUCATION
Book Code: SWUS1525
HOURS ALLOWED BY HOME-STUDY
HOURS REQUIRED
STATE
MANDATORY
Massachusetts
30
30
2 hours in anti-racism with a focus on oppression; 1 hour in anti-discrimination; 2 hour Board-approved training in domestic and sexual violence (one time requirement).
Minnesota Mississippi
40 40
20 20
2 hours in ethics; 4 hours in cultural responsiveness.
4 hours of ethics; 2 hours of cultural diversity/multicultural issues/cultural competency awareness; 1 hour in mandated reporting for all client populations. 3 hours of ethics; 2 hours of suicide assessment, referral, treatment, and management; 3 hours in explicit or implicit bias, diversity, inclusion, or cultural awareness/ competency/humility.
Missouri
30
15
Montana Nebraska
20 32 30
20 32 30
2 hours related to suicide prevention. 4 hours of mental health ethics.
Nevada
2 hours in suicide prevention and awareness; 6 hours in cultural diversity, equality and inclusion; 4 hours in ethics (LCSW and LISW require 36 CE hours).
New Hampshire New Jersey
40
20
6 hours of ethics and 3 hours of suicide prevention (Category A).
40
40
5 hours of ethics; 3 hours of social and cultural competence; 1 hour of prescription opioid drugs.
New Mexico
30 36 40 30 30 16
30 12 20 10 30
6 hours in cultural awareness.
New York
3 hours in appropriate professional boundaries.
North Carolina North Dakota
4 hours of ethics.
2 hours of ethics; LPCCs require an additional 10 clinical hours.
Ohio
3 hour of ethics; 3 hours of supervision training for supervising professional counselors. 3 hours of ethics; 3 hours of supervision for supervisors. *Oklahoma does not accept NBCC approval for Counselor continuing education credit. 6 hours of ethics (4 hours LMSW, 3 hours RBSW); 6 hours of cultural competency (4 hours LMSW, 3 hours RBSW); 2 hours of suicide risk assessment, training and management (all). 3 hours in ethics; 2 hours in state-approved child abuse recognition and reporting; 1 hour in suicide prevention.
Oklahoma
8
Oregon
40 - LCSW 30 - LMSW 20 - RBSW
40 - LCSW 30 - LMSW 20 - RBSW
Pennsylvania
30
30
Rhode Island South Carolina
30 40
8
3 hours in ethics; 3 hours in cross-cultural practice.
40
Supervisor must complete 10 hours of supervision oriented continuing education during every two-year licensure period.
South Dakota
30 30
30 20
None.
Tennessee
6 hours of ethics; 2 hours of Board-approved suicide prevention (every 4 years); 1 hour rules and regulations of the Board. 6 hours of ethics (completion of Texas jurisprudence exam will count as 1 hour of continuing education in ethics); 1 hour of human trafficking prevention; 6 hours of supervision if licensee has supervisor status; 3 hours in cultural diversity or competency.
Texas
30
30
Utah
40 20 15
15
6 hours of ethics; 2 hours of suicide prevention.
Vermont Virginia
5
1.5 hours in ethics.
15
3 hours in ethics or the standards of practice or laws (LCSWs are required 30 hours with 6 hours in ethics). 6 hours of ethics; 2 hours of health equity (every 4 years); 6 hours of approved training in suicide assessment, treatment and prevention (every 6 years). 1 hour of ethics and 2 hours must be specific to veterans and family members of veterans; 3 hours of supervision of clinical counseling if have supervisor status. 4 hours of ethics and professional boundaries (must be in an interactive format: live or synchronous).
Washington
36
36
West Virginia
30
10
Wisconsin
30
26
Wyoming
45 3 hours of ethics; 3 hours of suicide assessment or intervention. NOTE: CE Rules can change. Always check your state board for the most up-to-date information. 45
vi
Book Code: SWUS1525
SOCIAL WORK CONTINUING EDUCATION
Please read these instructions before proceeding. How To Complete This Book For Credit
• Go to EliteLearning.com/Book and enter code SWUS1525 in the book code box, then click GO . • Proceed to your exam. If you already have an account, sign in with your username and password. If you do not have an account, you’ll be able to create one now. • Follow the online instructions to complete your exam and finalize your purchase. Upon completion, you’ll receive access to your completion certificate. ONLINE FASTEST AND EASIEST!
Enter book code
SWUS1525
GO
Complete your CE
IF YOU’RE ONLY COMPLETING CERTAIN COURSES IN THIS BOOK: • Go to EliteLearning.com/Book and enter code that corresponds to the course below, then click GO. Each course will need to be completed individually, and the specified course price will apply.
BY MAIL
Complete the answer sheet and evaluation found in the back of this book. Include your payment information and email address. Mail to: Elite Learning, PO Box 997432, Sacramento, CA 95899
Mailed completions will be processed within 2 business days of receipt, and certificates emailed to the address provided. Submissions without a valid email address will be mailed to the postal address provided.
COURSES YOU’VE COMPLETED
HOURS PRICE CODE TO ENTER
ALL 15 HOURS IN THIS CORRESPONDENCE BOOK SWUS1525 If you are only completing individual courses in this book, enter the code that corresponds to the course below online. 15 $75.00
Cultural Humility in Behavioral Health
3
$27.00
SWUS03BH
Ethics in Behavioral Health Documentation: Reasons, Risks, and Rewards
3
$27.00
SWUS03ET
Managing Professional Boundaries
3
$27.00
SWUS03PB
Suicide Risk in Adults: Assessment and Intervention, 2nd Edition
3
$27.00
SWUS03SR
Adolescent Substance Use Disorders for Healthcare Professionals, 2nd edition Alzheimer’s Disease and Other Dementias: Symptoms, Stages, and Communication Strategies Expanded
1
$9.00
SWUS01AD
2
$18.00
SWUS02AL
v
SOCIAL WORK CONTINUING EDUCATION
Book Code: SWUS1525
Chapter 1: Cultural Humility in Behavioral Health 3 CE Hours
Release Date : January 15, 2023 Expiration Date : November 9, 2026 Upon successful completion of this course, continuing education hours will be awarded as follows: ● Social Workers and Psychologists: 3 Hours ● Professional Counselors: 3 Hours A reading-based asynchronous distance course. Colibri Healthcare, LLC, Provider 1147, is approved as an ACE provider to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Regulatory boards are the final authority on courses accepted for continuing education credit. ACE provider approval period: 5/5/2023 - 5/5/2026. Social workers completing this course receive 3 cultural competence continuing education credit(s). Author Adrianne E. Avillion, D.Ed, RN , is an accomplished
at conferences and conventions devoted to the specialty of continuing education and nursing professional development. Dr. Avillion owns and is the CEO of Strategic Nursing Professional Development, a business that specializes in continuing education for healthcare professionals and consulting services in nursing professional development. Adrianne E. Avillion has no significant financial or other conflicts of interest pertaining to this course. to enhance individualized learning and material retention. ● Provide required personal information and payment information.
nursing professional development specialist and healthcare author. She earned a doctoral degree in adult education and an MS in nursing from Penn State University, and a BSN from Bloomsburg University. Dr. Avillion has held a variety of nursing positions as a staff nurse in critical care, physical medicine, and rehabilitation settings, as well as numerous leadership roles in professional development. She has published extensively and is a frequent presenter How to receive credit ● Read the entire course online or in print. ● Answer the final examination questions at the end of the course. ○ A passing grade of 75% is required. Test questions link content to Learning outcomes as a method Colibri Healthcare, LLC implemented mechanisms prior to the planning and implementation of the continuing education activity, to identify and resolve conflicts of interest for all individuals in a position to control content of the course activity. Disclaimer The information provided in this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider Disclosures Resolution of conflict of interest
● Complete the Course Evaluation. ● Print your Certificate of Completion.
Sponsorship/commercial support and non-endorsement It is the policy of Colibri Healthcare, LLC not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners.
relative to diagnostic and treatment options of a specific patient’s medical condition.
©2024: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge of the areas covered. It is not meant to provide medical, legal, or professional advice. Colibri Healthcare, LLC recommends that you consult a medical, legal, or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation nor circumstances and assumes no liability from reliance on these materials. Quotes are collected from customer feedback surveys. The models are intended to be representative and not actual customers. Learning outcomes
After completing this course, the learner will be able to: Describe how factors of diversity can interfere in the therapeutic relationship with patients of diverse cultural backgrounds in various dimensions of diversity in the United States.
Describe the process of providing patient care with cultural humility with respect to the perspectives of oppression, privilege, and marginalization. Differentiate between multicultural competency and cultural humility. manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact health outcomes.
Implicit in Healthcare Implicit bias significantly affects how healthcare
professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gender identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can
Page 1
Book Code: SWUS1525
EliteLearning.com/Social-Work
Addressing implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures Course overview The purpose of this education program is to present an introduction to cultural humility and offers tools for psychologists and other behavioral healthcare professionals The American population is extremely diverse. In the upcoming years, the U.S. will continue to increase in diversity. The U.S. Census Bureau projects that by 2045 more than half of the population will belong to a minority group, defined by the Bureau as any group that identifies as having a background other than non-Hispanic White (Vespa, Medina, & Armstrong, 2020). Furthermore, by 2060 approximately 20% of the U.S. population will be foreign born (Vespa, Medina, & Armstrong, 2020). Professionals engaged in counseling must become increasingly self-aware and must understand both how their own unique individual experiences influence their worldviews and values and how the unique individual experiences of their clients influence each client’s worldviews and values. Further, various ethnic and racial groups may have a diversity of beliefs, social structures, interactional patterns, and expectations. In addition, each individual client has various intersecting dimensions of diversity that include socioeconomic class, sexuality, gender identification, and dis/ability. Because of these factors, counselors should cultivate the skills of practicing with cultural humility. Counselors who practice with cultural humility use four intersecting elements of ongoing self-reflection, self-critique, lifelong learning, and a commitment to advocacy and institutional change to guide their work with clients (Hook et al., 2013; Ratts et al., 2015). The cultural humility framework recognizes the concepts of power, privilege, and oppression and thus calls on counselors to be agents for change and promoters of social justice (Ratts et al., 2015). Counselors with humility are able to be “other-focused” and have an accurate view of themselves, their values, and their biases (Davis et al., 2016). These qualities allow counselors to practice as partners with clients from a variety of cultural, ethnic, and racial backgrounds as well as with clients who have various other dimensions of diversity. Culturally humble counselors are able to set aside their own beliefs and values and act as allies with clients, working toward positive personal change as well as advocating for larger societal change (Hook et al., 2013). When developing cultural humility, it is helpful for counselors to understand the sociopolitical landscape in the U.S. with regard to issues of race, immigration/refugee status, disability, sexual orientation, gender identification, and socioeconomic class (Ratts et al., 2015; Yeager & Bauer- Wu, 2022). The 2016 presidential election revealed the continued deep divisions within our country regarding attitudes toward racial and ethnic diversity, disability, sexual orientation, and gender identification. The Southern Poverty Law Center reported an increase in incidents of both harassment and intimidation during and after the election. These incidents were perpetrated against various minority groups, including African Americans; immigrants; the lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) population; Jewish individuals; and Muslims (Miller & Werner-Winslow, 2016). In the U.S., there are significant economic, health, education, employment, and housing
prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics.
to use when working with patients from diverse backgrounds in a culturally humble manner.
INTRODUCTION
disparities based on minority status (Agency for Healthcare Research and Quality [AHQR], 2021). The term minority status as used in this course pertains to race and ethnicity as well as to belonging to any marginalized group, such as having a disability; identifying as transgender, lesbian, gay, or bisexual; or ascribing to a minority religion. Social disparities in access to resources and experiencing acts of racism and discrimination can lead to higher degrees of stress and higher risk for developing mental and behavioral health issues. Despite perhaps having a higher need for services, clients with marginalized identities have less access to quality mental and behavioral health services (AHQR, 2021). This highlights the ethical responsibility counselors have to develop multicultural and social justice counseling competencies to effectively work and ally with diverse clientele. Cultural humility in counseling goes beyond counselors having knowledge of specific cultural and minority groups with whom they work. It is a way of practicing counseling that requires counselors to have an awareness of how their own culturally embedded ideals, beliefs, and prejudices affect their interactions with diverse clients (Hook et al., 2013). This requires counselors to continually and critically reflect on themselves and their interactions with clients. Through reflection, counselors can improve interactions with clients via honest appraisals of how their personal biases and deficits play into each counseling session and each relationship, allowing them to address power imbalances within the counseling relationships as well as at the institutional level. A culturally humble counselor needs to be able to provide modalities that transcend culture, ability, LGBTQ status, and class as well as integrate client-stated cultural and other considerations into treatment. Moreover, the counselor must recognize the roles that power, privilege, and oppression play in both the counseling relationship and the experiences of clients (Sue & Sue, 2021). A recognition of how power and oppression play out in clients’ lives calls on the counselor to take on a broader advocacy role when appropriate. Lifelong learning, critical self-reflection, and self-critique are needed to continuously hone therapeutic skills and learn new information that is imperative to facilitating the therapeutic relationship and addressing existing societal inequities (Hook et al., 2013; 2016). Given the breadth of issues that counseling with cultural humility encompasses, it is impossible for one short course to address all the intricacies of counseling with humility in a multicultural context. Despite the fact that more ethnic and racial minorities are entering the counseling profession, they still comprise a small percentage of mental and behavioral health workers compared with their White counterparts. According to the Bureau of Labor Statistics, in 2021, 86% of psychologists identified as white (BLS, 2022). This racial disparity remained true for social workers (i.e., 65%) and other mental health counselors (i.e., 70%) as well (BLS, 2022).
Book Code: SWUS1525
Page 2
EliteLearning.com/Social-Work
Across all mental and behavioral health workers nearly 70% are White, whereas 22% are Black and 13% are Hispanic or Latinx; the remaining mental and behavioral health workers are Native American or Asian. Most counselors are also from middle-class backgrounds, are without disability, and identify as heterosexual and cisgendered. Although the perspective of this course is influenced by the author’s own unique facets of diversity (e.g., White, heterosexual, cisgender, middle class, female, and currently nondisabled), it is likely that clinicians of various backgrounds will benefit from the course and be able to apply the content to their practices. Additionally, it is important to note that the term White , rather than Caucasian , is intentionally used in this course to reflect the view that race is socially constructed and that interactions among people of diverse backgrounds are embedded within structured and inequitable social relations. These inequities in social relations reflect a society
structured on White supremacy that serves as a foundation for the continued social and economic disparities existing between White people and people of color living in the same society. The status, power, and inclusion of whiteness within American culture are often unspoken and affect how individuals of differing backgrounds and identifications interact. The term White is used to reflect a concept of identity, rather than biological ancestry Bonds & Inwood, 2016). Similarly, the term cisgender female is used rather than simply female to illustrate both the invisibility and oppression of transgender individuals. This course presents an introduction to cultural humility and offers tools for social workers, mental health counselors, marriage and family therapists, and psychologists to use in working with diverse clients in a culturally humble manner.
DEFINITION OF CULTURAL HUMILITY
In the context of mental and behavioral healthcare services, cultural humility is defined as “a process of being aware of how people’s culture can impact their health behaviors and, in turn, using this awareness to cultivate sensitive approaches in treating patients” (Prasad et al., 2016). In contrast, cultural competency is described as ensuring that all healthcare professionals learn a quantifiable set of attitudes that allow them to work effectively within the cultural context of each patient. There is an endpoint to cultural competency. It ends with the termination of the mental and behavioral healthcare professional–patient relationship. On the other hand, cultural humility is an ongoing process, which requires continual self-reflection and self-critique. Cultural humility is a prerequisite to cultural competency. It forms a basis for effective, harmonious healthcare professional–patient relationships (Prasad, 2016). Cultural humility involves entering into a professional relationship with a patient by honoring the patient’s beliefs, customs, and values. Cultural competency is described as a skill that can be taught, trained, and achieved. This approach is based on the concept that the greater the knowledge a healthcare professional has about another culture, the greater their competence in practice. Cultural humility de-emphasizes cultural knowledge and competency, focusing instead on lifelong nurturing of self-reflection and self-critique, promoting interpersonal sensitivity, addressing power imbalances, and promoting the appreciation of intracultural variation and individuality (Stubbe, 2020). This humility exemplifies respect for human dignity. Definitions Diversity is a multidimensional concept that refers to many aspects of an individual that combine to comprise an overall sense of self. Moreover, diversity occurs within a cultural and social context where variances within the general population are treated differently based on the social, political, and cultural constructs existing within a society. Some dimensions of diversity include race, socioeconomic class, gender, sexual orientation (i.e., identifying as lesbian, gay, bisexual, queer/questioning [LGBQ]), gender identification (i.e., identifying as transgender), and disability. Although this is not an exhaustive list of all elements of individual diversity, it does address many prominent dimensions of diversity an individual may have as well as determine where that individual falls within the societal hierarchy. Dimensions of diversity also serve to privilege and empower some members of society while oppressing and marginalizing
An important part of cultural humility is identifying one’s own biases, self-understanding, and interpersonal sensitivity. It is important that all healthcare professionals nurture an appreciation for the many facets of each patient, including culture, gender, race, ethnicity, religion, sexual identity, and lifestyle. According to Yancu and Farmer (2017), healthcare professionals need both process (cultural humility) and product (cultural competence) to effectively provide care and interact with a culturally diverse society. Healthcare Consideration: A culturally humble healthcare professional needs to be able to provide services that transcend culture, ability, LGBTQ status, and class, as well as integrate healthcare professional–stated cultural and other considerations into treatment. Moreover, the healthcare professional must recognize the roles that power, privilege, and oppression play in both the counseling relationship and patient experiences (Sue & Sue, 2021). Self-Assessment Quiz Question #1 Which of the following statements pertains to the definition of cultural humility? a. Healthcare professionals must learn a quantifiable set of attitudes. b. Cultural humility is an ongoing process. c. Cultural humility is a skill that can be taught. d. Healthcare professionals know that there is an end point to cultural humility.
DIMENSIONS OF DIVERSITY IN THE U.S.
other members of society (Sue & Sue, 2021). Counselors need to understand the effects of diversity on a client in multiple domains, including a client’s mental and behavioral health and well-being. In some instances, a client’s identity constructs may be a source of great strength, and in other contexts they may contribute to increased stress. For example, on a microlevel simply being different in any way increases the threat of victimization and bullying (Menesini & Salmivalli, 2017). When individuals differ from the majority group, they are at risk of victimization. For instance, being the only individual in a school, workplace, or community group who possesses a certain trait increases the risk of victimization, regardless of what that trait may be (e.g., race, religion, socioeconomic status, LGBTQ, appearance).
Page 3
Book Code: SWUS1525
EliteLearning.com/Social-Work
Children with special needs and physical disabilities are consistently at an increased risk of victimization (Malecki et al., 2020). Adults who are members of a minority group suffer from higher rates of bullying (Lewis et al., 2011). Some minority workers have been shown to endure a bullying rate that is two to three times higher than that of their nonminority coworkers (Lewis et al., 2011). Namie, Christensen, and Phillips (2014) found that Hispanic Americans, African Americans, and Asian Americans all experienced higher rates of workplace bullying, both witnessing and targeting, than White Americans and that their individual group rates were each higher than the national average. In the workplace, as in school settings, differences of any type increase a person’s risk of being bullied or experiencing other forms of victimization. For decades, “social psychologists have repeatedly demonstrated that individuals who do not belong to the group are devalued” and that they are more likely to be used as scapegoats in the workplace (Zapf & Einarsen, 2011, p. 188). Being a victim of bullying and other oppression results in a much greater likelihood of depression and posttraumatic stress disorder (PTSD) in adolescents (Kosciw et al., 2020; Schuster & Bogart, 2013). Adult victims of workplace bullying, or community oppression, will show signs of stress and trauma (Hogh et al., 2011). The inability to concentrate, insomnia, mood swings, anxiety, depression, and physical symptoms eventually cause impairment at school and work, resulting in increased rates of absenteeism or presenteeism (being present at work but unable to function optimally; Einarsen et al., 2011; Lutgen-Sandvik & Arsht, 2014). As such, the context of a client’s diversity elements may have a direct effect on the client’s reasons for presenting to counseling in the first place. Intersectionality is a concept that is used to describe how these various dimensions come together to privilege or oppress individuals and groups of individuals. Race, ethnicity, and immigration The U.S. is a nation of immigrants. The racial, ethnic, and immigrant diversity within American society is often cited as one of its greatest strengths. However, it has also been a challenge for the U.S. and for Americans in terms of fully accepting and embracing the broad array of immigrant groups that have become American. Historically, every new immigrant group has experienced various degrees of prejudicial and discriminatory treatment and exclusion from mainstream society. However, the experience of many European (e.g., Irish, Italian, German) immigrants was one of initial discrimination followed by swift acculturation and assimilation, likely aided by their physical appearance and language being similar to those of earlier settlers. Asian and Latina/o immigrants have experienced prejudicial treatment, possibly because of readily identifiable physical and language differences. Historical evidence of mistreatment is well documented, with perhaps one of the most egregious examples being the internment of Japanese Americans during World War II (Nagata et al., 2015). Although Americans often think of the journey of voluntary immigration of the many ethnic groups that come to America to build a “better” life, the legacy of the forced immigration of African American slaves is often overlooked. African Americans endured 250 years of enslavement followed by 60 years of “separate but equal” status as well as continuing racist practices in education, housing, health, and the criminal justice system. The systemic and continuous oppression of African Americans is a direct legacy of this forced immigration and has resulted in
Intersectionality is defined as “multiple, intersecting identities and ascribed social positions (e.g., race, gender, sexual identity, class) along with associated power dynamics, as people are at the same time members of many different social groups and have unique experiences with privilege and disadvantage because of those intersections” (Rosenthal, 2016, p. 475). Each individual has a multitude of diverse identities; some are visible and some are not readily identifiable. Each of the identities intersects with the other identities. The multiple intersections can serve to provide for further oppression and marginalization or further power and privilege, and/ or they could mitigate one another, providing some facets of privilege and others of oppression. For example, an African American college professor who is a heterosexual woman with a doctoral degree is often oppressed and marginalized because of her race and gender; however, as a highly educated academic who is not gay, she experiences power and privilege, particularly in the academic classroom setting as the course professor. Another example is a female student who has experienced poverty on and off throughout her life cycle and identifies as biracial and gay; she may experience multiple identities that compound her oppression and marginalization (i.e., female, poor, gay, biracial). The concept of intersectionality provides a useful framework for healthcare professionals, as it helps them to understand the complexity of patients’ diverse identities. Further, it provides a structure for understanding the multitude of factors that may cause a patient to be oppressed and/or privileged within the context of American society. In this same manner, it is important to recognize that culture is best described as fluid and subjective, as will be discussed in greater detail with respect to providing patient care with cultural humility. enduring educational, health, and wealth disparities (Bunch, 2016). “New” immigrants from Afghanistan, Haiti, and other war- torn or environmentally impacted countries are experiencing prejudicial treatment in society and healthcare today. The economic and social burden of caring for these immigrants, in addition to the typical flow of immigrant populations, has aroused discriminatory attitudes in society and even in healthcare professionals that may already be stressed by COVID patient care. Mental and behavioral healthcare professionals’ understanding of the differential treatment of current and past immigrant groups based upon ethnic, racial, religious, and linguistic background is paramount to understanding their patients. The way in which individuals and groups are treated on a sociopolitical (macro) level, group (mezzo) level and on a daily individual interactional (micro) level necessarily affects their views and understanding of the world in which they live. From a person-in-environment perspective, individuals act upon the environment, and the environment acts upon and reacts to the individual. Thus, while individuals help shape the environment around them, the environment also shapes the individual (Hutchison, 2021). A demographic breakdown of the diversity in the U.S. is provided in Tables 1 and 2. This breakdown may help healthcare professionals better conceptualize the potential diversity of experiences among their patients.
Book Code: SWUS1525
Page 4
EliteLearning.com/Social-Work
Demographics The U.S. has more immigrants than any other country in the world. Currently, more than 40 million people living in the U.S. were born in another country. This figure represents one-fifth of the world’s immigrants. Nearly every country in the world is represented among U.S. immigrants (Pew Research Center, 2020b). In 2018, there were a record 44.8 million immigrants living in the U.S. This figure represents 13.7% of the nation’s population. Since 1965, the number of immigrants living in the U.S. has more than quadrupled. Since 1970, the number of immigrants has nearly tripled (Pew Research Center, 2020a). Table 1 provides a breakdown of the U.S. foreign- born population by national origin. Table 1: Foreign-Born Population by Place of Birth 2018 Region Number of People Percentage Mexico 11,182,111 25% East and Southeast Asia 8,648,525 19.3% Europe 4,848,270 10.8% Caribbean 4,463,891 10% South America 3,304,380 7.4% Central America 3,590,330 8% South Asia 3,668 8.2% Sub-Saharan Africa 2,032,470 4.5% Middle East-North Africa 1,784,898 4% Canada and Other North America 827,093 1.8% Oceania 246,371 0.6% Central Asia 131,854 0.3% Total 44,760,622 100% Note : Based on data from the Pew Research Center (2020a). Tables 2-4 provides a breakdown of the US population by race. Evidence-based practice! Data show that the population varies significantly by place of birth and race. To practice cultural humility, mental and behavioral healthcare professionals must be aware of the populations they serve. Table 2: Population by Race Self-Identification 2018 Race Number of People Percentage White 236,102,692 72.2% Black or African American 41,683,829 12.7% Asian 18,449,856 5.6% Some Other Race 16,273,008 5% Two or More Races 11,224,731 3.4%
Table 3: Population by Race Self-Identification US Born Race Number of People Percentage White 215,726,882 76.4% Black or African American 37,413,425 13.2% Two or More Races 10,169,825 3.6% Some Other Race 9,655,701 3.4% Asian 2,627,659 2.2%
Native American Indian and Alaska Native Native Hawaiian and other Pacific Islander
2,627,659
0.9%
460,543
0.2%
Note : Based on data from the Pew Research Center (2020a). Table 4: Population by Race Self-Identification Foreign
Born Race White Asian
Number of People 20,375,810 12,097,155 6,617,226 4,270,404
Percentage
45.5%
27%
Some Other Race Black or African American Native American Indian and Alaska Native Native Hawaiian and Other Pacific Islander
14.8%
9.5%
198,677
0.4%
146,444
0.3%
Two or More Races 0.2% Note : Based on data from the Pew Research Center (2020a). Self-Assessment Quiz Question #2 460,543 In 2018, from which country/region did the highest number of foreign-born people residing in the US come from by place of birth? a. South America. b. East and Southeast Asia. c. Mexico. d. Sub-Saharan Africa. Mental and behavioral healthcare professionals must be careful not to make sweeping generalizations regarding the characteristics or needs of any population. Further, patients are influenced by a variety of factors, including level of acculturation (to be discussed later), immigration experience, experiences with discrimination, and ability to speak English. Therefore, it is imperative that healthcare professionals ask patients about their personal experiences and important events in their lives. Some cultural generalizations may help clinicians increase their knowledge of specific cultures and enhance their understanding of a portion of patients’ differing experiences. However, this is not intended to shift the healthcare professional’s focus away from developing a better understanding of the dynamics of race, immigration, and other facets of diversity within the current social, economic, and political environment of the U.S. Mental and behavioral healthcare professionals are better prepared to both understand and help their patients if they are able to understand the
Native American Indian and Alaska Native Native Hawaiian and other Pacific Islander
2,826,336
0.9%
606,987
0.2%
Note : Based on data from the Pew Research Center (2020a).
Page 5
Book Code: SWUS1525
EliteLearning.com/Social-Work
cultural climate in which their diverse patients live and that climate’s role in accommodating or marginalizing them. Moreover, healthcare professionals will provide better care for their patients if they develop a better understanding of how they personally are accommodated and marginalized by American culture. Race, ethnicity, and immigration Poverty Poverty is often a consequence of immigrants having fled war zones, disaster areas, and regions of extreme high unemployment. More recently, the COVID-19 global pandemic shifted the trend in poverty rates which had been declining for a decade. Following the 2008 world financial crisis, U.S. poverty rates peaked in 2010 at 15.1% before steadily declining to a rate of an historic low of 10.5% in 2019 (Statista Research Department, 2022). Beginning in 2020, the official poverty rate was 11.4%, up 1% from 2019 which marked the first annual increase since 2009. In 2020, there were 37.2 million people in poverty, about 3.3 million more than in 2019 (U.S. Census Bureau, 2020). However, poverty is not equally distributed throughout the American population. According to new research, 74.7 million people have lost work since the start of the pandemic, with the majority of jobs lost in industries that were already paying below- average wages. Many who lost work and income are running out of money and savings. In January 2022, some 24 million adults reported experiencing hunger, and more than six million said they feared being evicted or foreclosed on in the next two months due to their inability to make rent or mortgage payments. Living in a stressful state of poverty can lead to an increase or onset of psychological distress. The instability that often accompanies mental illness can also lead to poverty. The cycle continues and grows as more people find themselves reeling from the pandemic's physical, financial, and emotional impacts. By contrast, higher-income people have been relatively unscathed economically (Human Rights Watch, 2022), and certain groups are disproportionately impacted by poverty. Women, children, and racial and ethnic minorities experience poverty more often than men, working adults, and White people, and individuals with disabilities experience poverty more often than those without current disabilities (Institute on Disability, 2020; U.S. Census Bureau, 2020). The unequal distribution of poverty across the population reflects the disparities in opportunities these subpopulations experience throughout their lives. Some examples of the disparity of opportunities include a disproportionate number of racial and ethnic minorities living in low- income neighborhoods and experiencing insufficient educational opportunity as well as women continuing to earn less than men (the most current data show that women earn 83 cents for each dollar men earn; U.S. Bureau of Labor Statistics, 2022). Evidence-based practice! Research shows that the poverty rate in the U.S. is increasing. Healthcare professionals must be aware of data relating to poverty and work to decrease the growing problem of poverty. Key points related to income and poverty in the U.S. include the following (U.S. Census Bureau, 2020): ● Between 2019 and 2020, the poverty rate increased for non-Hispanic Whites and Hispanics. Among non- Hispanic Whites, 8.2% were in poverty in 2020, while Hispanics had a poverty rate of 17.0%. Among the major racial groups examined in the Census Bureau’s report, Blacks had the highest poverty rate (19.5%) but did not
status are only a few of the facets of diversity that affect patients. Other facets of diversity include socioeconomic status, disability, sexual orientation, religion, and gender identification. These facets of diversity can serve as dimensions that marginalize and/or oppress patients as well.
experience a significant change from 2019. The poverty rate for Asians (8.1%) in 2020 was not statistically different from 2019. ● Poverty rates for people under the age of 18 increased from 14.4% in 2019 to 16.1% in 2020. Poverty rates also increased for people ages 18 to 64, from 9.4% in 2019 to 10.4% in 2020. The poverty rate for people ages 65 and older was 9.0% in 2020, which was not statistically different from 2019. ● Between 2019 and 2020, poverty rates increased for married-couple families and families with a woman not working outside the home. The poverty rate for married- couple families increased from 4.0% in 2019 to 4.7% in 2020. In families that the woman did not work outside the home, the poverty rate increased from 22.2% to 23.4%. The poverty rate for families that the man did not work outside the home was 11.4% in 2020, which was not statistically different from 2019. Income data from the Census Bureau include the following information (U.S. Census Bureau, 2020): ● Median household income was $67,521 in 2020, a decrease of 2.9% from the 2019 median of $69,560. This is the first statistically significant decline in median household income since 2011. ● The 2020 real median incomes of family households and nonfamily households decreased 3.2% and 3.1%, respectively, from their 2019 estimates. ● The 2020 real median household incomes of non- Hispanic Whites, Asians, and Hispanics decreased from their 2019 medians, while the changes for Black households were not statistically significant. ● In 2020, real median household incomes decreased 3.2% in the Midwest and 2.3% in the South and the West from their 2019 medians. The change for the Northeast was not statistically significant. Women in poverty More women than men are living in poverty in the U.S. Men who migrate for employment or to avoid conscripted military work often leave women behind. Migrating across hundreds of miles and difficult terrain is often not feasible for women and children. Basic information about women in poverty includes the following (Bleiweis et al., 2020): ● Of the 38.1 million people living in poverty in 2018, 56%, or 21.4 million, were women. ● Nearly 10 million women live in deep poverty, which is defined as falling below 50% of the federal poverty line. ● The highest rates of poverty are experienced by American Indian and Alaska Native (AIAN) women, Black women, and Latinas. About one in four AIAN women live in poverty. This is the highest rate of poverty among women or men of any racial or ethnic group. ● Unmarried mothers have higher rates of poverty than married women, with or without children, and unmarried women without children. Nearly 25% of unmarried mothers live below the poverty line. ● In 2018, there were 11.9 million children under the age of 18 living in poverty. This accounts for 31.1% of those living in poverty.
Book Code: SWUS1525
Page 6
EliteLearning.com/Social-Work
Page i Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44 Page 45 Page 46 Page 47 Page 48 Page 49 Page 50 Page 51 Page 52 Page 53 Page 54 Page 55 Page 56 Page 57 Page 58 Page 59 Page 60 Page 61 Page 62 Page 63 Page 64 Page 65 Page 66 Page 67 Page 68 Page 69 Page 70 Page 71 Page 72 Page 73 Page 74 Page 75 Page 76 Page 77 Page 78 Page 79 Page 80 Page 81 Page 82 Page 83 Page 84 Page 85 Page 86 Page 87 Page 88 Page 89 Page 90 Page 91 Page 92 Page 93 Page 94 Page 95 Page 96 Page 97 Page 98 Page 99 Page 100 Page 101 Page 102 Page 103 Page 104 Page 105 Page 106 Page 107 Page 108 Page 109 Page 110 Page 111 Page 112 Page 113 Page 114 Page 115 Page 116 Page 117 Page 118 Page 119 Page 120 Page 121 Page 122 Page 123 Page 124 Page 125 Page 126 Page 127 Page 128 Page 129 Page 130 Page 131 Page 132 Page 133 Page 134 Page 135 Page 136 Page 137 Page 138 Page 139 Page 140 Page 141 Page 142 Page 143 Page 144Powered by FlippingBook