What is cultural competence and how do we as practitioners work towards having it?

The phrase cultural competence or cultural awareness has in recent weeks become a buzzword across many fields including behavior analysis. This word or concept should not be new to us though. The ethical code provided by the BACB specifically indicates that as behavior analysts we should practice cultural sensitivity and understanding of the clients we serve. Although this is part of our ethical code it is unfortunately not a part of our course requirements and many of us do not receive direct training or instruction related to cultural issues. If we are to provide the clients and communities we serve with the best possible treatment we must make an effort to understand culture and become more aware of its presence in ourselves and others. 

 

First things first, what is culture? 

  • Generally, it is a system of shared beliefs, values, customs, and behaviors that the members of a society use to manage their world and one another. In behavior analytic terms, it can be further defined as various contingencies of reinforcement prevailing in the environment in which we are born and that we experience throughout our lives. Our personal culture offers contingencies that shape and affect our behavior. It directly relates to our opinions and perceptions regarding socially appropriate behavior.
  • What behaviors does culture impact?
    • ALL OF THEM! Almost all of our operant behavior is affected by our culture.
      • Social interactions and social behaviors
      • Language
      • Problem solving 
      • Decision making
      • Gender roles
      • Clothing choices
      • Nonverbal communication behaviors
      • Parenting
      • Values and beliefs
      • Religion

Next, what is cultural competence and is that even the right term? 

There are three terms that are commonly tossed around when discussing knowledge of culture in the professional world. These are cultural competence, cultural awareness, and cultural humility. Although these have been at times used interchangeably they have slightly different implications. 

    • Cultural competence – a set of congruent behaviors, attitudes, and polices that come together in a system, agency, or those professions to work effectively in cross-cultural situations. The elements that contribute to achieving this include: (Fong & Tanake, 2013)
      • Valuing diversity
      • Having the capacity for cultural self-assessment
      • Being conscious of the dynamics inherent when cultures interact
      • Having institutionalized culture knowledge
      • Developing adaptations to service delivery reflecting an understanding of cultural diversity
    • Cultural awareness – the ability to identify the reinforcement and punishment contingencies that have been established by yourself, your colleagues, family, and any other social group you may belong to (Fong et al., 2016)
    • Cultural humility – the ability to maintain an interpersonal stance that is other-oriented in relation to aspects of cultural identity that are most important to the person. The key feature of humility is that it indicates a lifelong commitment to training and understanding cultural issues. (Wright, 2019) 
  • So which one do we use?
    • Cultural awareness is a useful term but may only be a step in the full process of taking into account the culture of others. Becoming aware and identifying the contingencies of other people indicates understanding and reflection but not necessarily action. 
    • Cultural competence seems to be the most used term but it may reflect the wrong idea that our cultural education has a stopping point. 
    • Cultural humility may be better suited for our practices as competence indicates a process that can be completed. Yet, as others have said you will never be competent enough. It is indeed an ongoing learning process that takes both education and practice. The concept of cultural humility has already been adopted by other fields for training such as medical, education, and social work. (Wright, 2019)

 

How do we work toward gaining cultural humility? 

  • Self-awareness and reflection 
    • Label and identify your own biases 
      • If you have difficulty consider using a self-assessment tool or implicit bias test 
    • How might your biases affect your relationships and treatment with clients 
    • Have discussions with other professionals about culture and cultural issues you have encountered in your practice
    • Investigate therapeutic awareness tools such as ACT or mindfulness
  • Self-monitoring and data collection

    • Define culturally aware behaviors and what actions you will take to improve or change your behavior 
    • Collect data on those behaviors 
    • Involve a colleague to keep yourself accountable 
  • Considerations for practice 
    • Make an effort to understand the cultural norms of our clients 
      • What behavior patterns might you view as problematic that may actually be common for the clients culture? 
    • Consider the language used for assessments and other interviews or documents provided to families 
    • Involve the family! Also, consider including additional community members that may have an impact or understanding of the client’s culture. 
  • Educate yourself

    • Read books 
    • Attend trainings 
    • Become involved with or study research related to cultural competence, cultural humility, and compassionate care in behavior analysis (you can find some of these below in resources) 

 

Resources:

Self-assessment tools:

How Do You Relate to Various Groups of People in Society?

Diversity Self-Assessment

Natural Center for Cultural Competence – Self Assessments

Tools for Assessing Cultural Competence 

 

Articles:

Cultural Humility in the Practice of Applied Behavior Analysis

Developing the Cultural Awareness Skills of Behavior Analysts

Multicultural Issues in Autism

 

Ravindran, N., & Myers, B. J. (2012). Cultural influences on perceptions of health, illness, and disability: A review and focus on autism. Journal of Child and Family Studies, 21(2), 311-319.

 

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