female, and nondisabled), it is expected that clinicians of various backgrounds will benefit and find applicability to their practices. Regardless of your racial/ethnic background, socioeconomic status, age, gender, sexuality, and disability status, a commitment to cultural humility is the expectation for all mental health practitioners. Additionally, it is essential 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 between White people and people of color living in the same community. The status, power, and inclusion of Whiteness within the American culture are often unspoken and affect
how individuals of differing backgrounds and identifications interact. Similarly, the term “cisgender female” is used rather than simply “female” to illustrate the invisibility and oppression of transgender individuals. Cultural humility looks at the intersectionality of multiple diversity points, including race, ethnicity, socioeconomic status, education, age, gender, and other identifications with which the client may align (Fisher-Borne et al., 2015). Unlike the concepts of cultural competency and multicultural competency, which focus on gaining knowledge about cultural groups differing from the individual’s own with the hopes of better understanding those cultures and thus better meeting the needs of different groups who enter counseling, cultural humility focuses on the cultural context within the U.S. that marginalizes and oppresses some groups of people while privileging and empowering other groups of people (Foronda et al., 2016).
CULTURAL COMPETENCE
Cultural competence means a commitment to learning about cultural differences, developing cross-cultural skills, and learning from our mistakes along the way. The term multicultural competence surfaced with a mental health publication by psychologist Paul Pedersen (1988) at least a decade before the expression cultural competence became popular. Pedersen’s multicultural competence model emphasizes awareness, knowledge, and skills. Mental health and medical care professionals have been at the forefront of promoting cultural competence. The consequences of a Cultural Competence, Healthcare, and Treatment Cultural competence in healthcare means delivering effective, quality care to individuals with diverse beliefs, attitudes, values, backgrounds, and behaviors (Tulane University, 2021). This requires systems to personalize health care according to cultural differences. It also requires understanding the potential impact that cultural differences can have on the counseling process. Culture is not stagnant but is a changing system of beliefs and values shaped by our interactions with one another, institutions, media, and technology, and by the socioeconomic determinants of our lives. In healthcare, cultural humility may be defined as being aware of how people’s culture can impact their health behaviors and, in turn, using this awareness to cultivate sensitive approaches to treating patients. To deliver individualized, patient-centered care, a provider must consider patients’ diversity of lifestyles, experiences, and perspectives to collaborate in joint decision-making. Patient- centered care can enhance equity in health care delivery; cultural sensitivity may enhance patient-centered care. Perceived practitioner competence is a factor that varies based on the racial/ethnic background of the patient. Research has shown that perceived physician cultural competency differs most among racial groups, with White patients reporting the highest degree of perceived cultural competency in their physician (Galic, 2021). It is not surprising that White patients report higher levels of perceived cultural competency with their physicians because most of the physicians in this country can be described as White. In other words, it is expected that individuals will feel more comfortable with and more easily trust individuals they perceive to be similar. Accordingly, data shows that perceived cultural competence is much lower among African American women. Galic (2021) found that nearly half of the African American women they studied reported that their physician did not understand their cultural background. Half is a significant amount when considering healthcare because
poor diagnosis due to a lack of cultural understanding, for example, can be very costly to the patient—especially in medical service delivery. The notion of cultural competence is also challenged by intersectionality, which suggests that the beliefs and values a patient brings to the clinical encounter are shaped by the intersection of their different characteristics, such as race, class, gender, and sexual orientation. feeling misunderstood by your physician could amount to efforts or a lack of efforts that result in poorer health or death. Differences between healthcare providers and patients can affect communication. This can, in turn, impact clinicians’ and patients’ decisions about treatment. For example, a clinician may misinterpret a patient’s silence as a lack of interest in receiving care. As a result, the clinician may not order a diagnostic test when the patient’s response reflects their respectful behavior. When healthcare providers fail to recognize the differences between them and their patients, they may inadvertently deliver lower-quality care. Cultivating skills that improve cross-cultural communication can be crucial in delivering equitable care. Cultural competency helps reduce disparities in healthcare by promoting seamless adaptation of services to meet unique needs throughout the community, including racial and ethnic disparities. In order to increase the cultural competence of the healthcare delivery system, health professionals must be taught how to provide services in a culturally competent manner. Although many different training courses have been developed across the country, these efforts have not consistently been standardized or incorporated into training for health professionals. Training courses and teaching methods vary greatly, ranging from three-hour seminars to semester-long academic courses. Moreover, cultural competence is a process rather than an ultimate goal and is often developed in stages by building upon previous knowledge and experience. Health systems are beginning to adopt comprehensive strategies to respond to the needs of racial and ethnic minorities for numerous reasons. There are increasingly more state and federal guidelines that encourage or mandate more excellent responsiveness of health systems to the growing population diversity. Also, many health systems
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