Cross Cultural Skills & Strategies Cross Cultural Skills & Strategies For Helping ProfessionsFor Helping Professions

Spring AcademySpring AcademyPrevention & Treatment ExchangePrevention & Treatment Exchange

20092009

C. Truth Griffeth, LCSW, CDP, NCACC. Truth Griffeth, LCSW, CDP, NCACtruth@nativeinstincts.comtruth@nativeinstincts.com

206.399.5846206.399.5846

ObjectivesObjectives

1.1. Gain awareness of own social identity Gain awareness of own social identity group membershipsgroup memberships

2.2. Examine behavioral consequences and Examine behavioral consequences and effects of unintentional biases in helping effects of unintentional biases in helping relationships relationships

3.3. Learn indicators of a professional who is Learn indicators of a professional who is striving for cultural “competency”striving for cultural “competency”

4.4. Review specific clinical considerations for Review specific clinical considerations for working across difference and practical working across difference and practical ways to increase cultural knowledge/skillsways to increase cultural knowledge/skills

5.5. Share resources for future studyShare resources for future study

Premise:Premise:

You already have cross-cultural skillsYou already have cross-cultural skills You have altered or adapted skills in a You have altered or adapted skills in a

cultural contextcultural context

Challenges:Challenges:

Lifetime process: no instant “competence”Lifetime process: no instant “competence” Breadth vs. depthBreadth vs. depth Challenges and risks involved in exploring Challenges and risks involved in exploring

this topic in mixed groups—may be first this topic in mixed groups—may be first timetime

Complex subject with emotionally charged Complex subject with emotionally charged history and meaninghistory and meaning

Language, definitions, meaningsLanguage, definitions, meanings Success will depend on Success will depend on RISKRISK && ACTIONACTION……

Reflection Exercise:Reflection Exercise:Exploring and learning about Exploring and learning about each other’s social identities each other’s social identities while reflecting on our own while reflecting on our own

experiences… experiences…

Power FlowerPower Flower

Behavioral Consequences of Behavioral Consequences of Misunderstanding:Misunderstanding:

Reduced retention/participation in txReduced retention/participation in tx Dx: inaccurate, over or bothDx: inaccurate, over or both Staff assignment/timeStaff assignment/time Tx planning/research not effectiveTx planning/research not effective Utilization/advocacy needsUtilization/advocacy needs Misunderstood family dynamics and cultural Misunderstood family dynamics and cultural

beliefsbeliefs Delayed careDelayed care Others?Others?

““Colorblindness” Colorblindness” Overconfidence/over identificationOverconfidence/over identification Stereotyping/dualistic thinkingStereotyping/dualistic thinking

Acculturation and assimilationAcculturation and assimilation Individual vs. collective identity Individual vs. collective identity Who gets “Who gets “named”named”: the creation and : the creation and

perpetuation of “otherness”perpetuation of “otherness” Terms like: “Underprivileged” Terms like: “Underprivileged”

“Underserved”“Underserved” ““Teach me” syndrome: risk, power & Teach me” syndrome: risk, power &

invasive questioning invasive questioning

Consider Effects of:Consider Effects of:

Consider Effects of:Consider Effects of:

Ignorant of—or ignoring— Ignorant of—or ignoring— organizational/professional culture and hxorganizational/professional culture and hx

““Reverse” discrimination/affirmative Reverse” discrimination/affirmative actionaction

Collusion/passivityCollusion/passivity ““Multiethnic” practice (agenda)Multiethnic” practice (agenda) Exclusive language and examples in tx Exclusive language and examples in tx ““Politically correct” (agenda)Politically correct” (agenda) Other examples?Other examples?

Striving for Competency…Striving for Competency…(Adapted from “Readings for Diversity and Social Justice” Adams et al, 2000.)(Adapted from “Readings for Diversity and Social Justice” Adams et al, 2000.)

Accepts the fact that they have much Accepts the fact that they have much to learn about others and to learn about others and themselves; themselves; takes responsibility for takes responsibility for learninglearning how oppression works in how oppression works in everyday life everyday life

Feels good about own social group Feels good about own social group membership; is comfortable and membership; is comfortable and proud of own identityproud of own identity

Listens to and respects the Listens to and respects the perspectives and experiences of perspectives and experiences of target group memberstarget group members

Acknowledges unearned privilege(sAcknowledges unearned privilege(s) ) and works to eliminate or change and works to eliminate or change into rights that target group into rights that target group members also enjoymembers also enjoy

Recognizes that unlearning Recognizes that unlearning oppressive beliefs and actions is a oppressive beliefs and actions is a lifelong processlifelong process, not a single event, , not a single event, and welcomes each learning and welcomes each learning opportunityopportunity

Is willing to Is willing to take riskstake risks, try new , try new behaviors, act in spite of own fear behaviors, act in spite of own fear and resistance from other agentsand resistance from other agents

Acts against social injusticeActs against social injustice, believing , believing it is in her/his own self interest to do soit is in her/his own self interest to do so

Is committed to taking action against Is committed to taking action against social injustice in own sphere of social injustice in own sphere of influenceinfluence

Is willing to Is willing to make mistakesmake mistakes, learn from , learn from them and try again; willing to be them and try again; willing to be confronted about own confronted about own behavior/attitudes and consider behavior/attitudes and consider changechange

Practices self carePractices self care

Understands the connections among Understands the connections among all forms of social injusticeall forms of social injustice

Knows how to cultivate support from Knows how to cultivate support from other alliesother allies

Has the ability to obtain culturally Has the ability to obtain culturally relevant information in the helping relevant information in the helping relationshiprelationship

Considers: profession, self, agency, Considers: profession, self, agency, clientclient

Understands that helping and healing Understands that helping and healing are culturally specific activitiesare culturally specific activities

Some Clinical Considerations:Some Clinical Considerations:

Physical spacePhysical space Body language/posture/contactBody language/posture/contact Sharing the expert roleSharing the expert role Tone, cadence, volume/addressTone, cadence, volume/address Cultural values: family in healing, Cultural values: family in healing,

time, agendas, etiologytime, agendas, etiology Motivation for txMotivation for tx Use of self disclosureUse of self disclosure

Clinical Considerations Clinical Considerations

Invasive questions, how helpful Invasive questions, how helpful clinically?clinically?

Use of statements as questions— “help Use of statements as questions— “help me understand….”me understand….”

Consider translations, interpretations Consider translations, interpretations and contextsand contexts

Inclusive language and examplesInclusive language and examples Use of JargonUse of Jargon Other historical, cultural & ecological Other historical, cultural & ecological

factors factors

Cultural AssessmentCultural AssessmentAurthur Kleinman, 1978Aurthur Kleinman, 1978

Kleinman A, Eisenburg L, Good B, Culture, Illness, and Care. AIM, 1978;88:251.Kleinman A, Eisenburg L, Good B, Culture, Illness, and Care. AIM, 1978;88:251.

““Every illness is a personal story”Every illness is a personal story” What do you call the problem?What do you call the problem? What do you think has caused the problem?What do you think has caused the problem? Why do you think it started when it did?Why do you think it started when it did? What do you think your sickness does to you? How What do you think your sickness does to you? How

does it work?does it work? How severe is your sickness? Will it have a short or How severe is your sickness? Will it have a short or

a long course?a long course? What are the problems your sickness has caused?What are the problems your sickness has caused? What do you fear the most about your sickness?What do you fear the most about your sickness? What kind of treatment do you think you should What kind of treatment do you think you should

receive? receive? What are the most important results you hope to What are the most important results you hope to achieve from these treatments?achieve from these treatments?

Learning About One’s Own CultureLearning About One’s Own Culture

Historic accounts/StoriesHistoric accounts/Stories Talk with elders, relativesTalk with elders, relatives Learn history of traditionsLearn history of traditions TravelTravel GenealogyGenealogy Go to cultural eventsGo to cultural events ResearchResearch MuseumsMuseums Teach othersTeach others Other?Other?

Learning About Other’s CulturesLearning About Other’s Cultures

Active listening/AskActive listening/Ask Attending festivals and cultural eventsAttending festivals and cultural events Arts: Music/ReadingArts: Music/Reading ImmersionImmersion FoodFood TravelTravel Community involvement/volunteerCommunity involvement/volunteer Exchange studentsExchange students Other?Other?

Ways to Gather Relevant Cultural Ways to Gather Relevant Cultural Information in Clinical PracticeInformation in Clinical Practice

Listen to client: including px, non verbalListen to client: including px, non verbal Ask relevant questionsAsk relevant questions Cultural peer review of assessmentCultural peer review of assessment Collaboration with other agenciesCollaboration with other agencies Research/internetResearch/internet Don’t assumeDon’t assume SupervisionSupervision Continuing ed/trainingsContinuing ed/trainings Assess processAssess process Other?Other?

Ways to Change Organizational Ways to Change Organizational CultureCulture

Education/share knowledgeEducation/share knowledge Speak upSpeak up Healthy staff/heal individual woundsHealthy staff/heal individual wounds Be passionateBe passionate Management trainingManagement training Advance careerAdvance career Role modelingRole modeling Build trust, team, supportBuild trust, team, support Process improvementProcess improvement ListenListen RebelRebel Others?Others?

Action Plan:Action Plan: What action do you want to take to What action do you want to take to

increase cultural competency and/or increase cultural competency and/or disrupt racism in your practice and/or disrupt racism in your practice and/or organization?organization?

What resources or materials, if any, What resources or materials, if any, would you need to achieve your goal?would you need to achieve your goal?

What behaviors or steps would taking What behaviors or steps would taking this action entail?this action entail?

What is a realistic timeline for What is a realistic timeline for carrying out the steps involved in this carrying out the steps involved in this action plan?action plan?

What hazards or risks are involved?What hazards or risks are involved? What obstacles might you What obstacles might you

encounter?encounter? What could you do to overcome What could you do to overcome

these obstacles?these obstacles? What supports do you have?What supports do you have? Where could you find more Where could you find more

support?support? How could you evaluate your How could you evaluate your

success?success?

Action Plan:Action Plan:

Resources:Resources:

www.nattc.orgwww.nattc.org

http://xculture.org/http://xculture.org/

http://ethnomed.org/http://ethnomed.org/

www.tolerance.orgwww.tolerance.org

http://www.diversityrx.org/http://www.diversityrx.org/

Resources/References:Resources/References: ““What Language Does Your Patient Hurt In?,” What Language Does Your Patient Hurt In?,”

Salimbene, S. Salimbene, S. ““A Peoples History of the United States,” Zinn, H., New A Peoples History of the United States,” Zinn, H., New

York: Perennial, 2001.York: Perennial, 2001. ““Race, Class, and Gender in the United States,” Race, Class, and Gender in the United States,”

Rothenberg, P. (Ed.), New York: Worth Publishers, Rothenberg, P. (Ed.), New York: Worth Publishers, 2001.2001.

““Pedagogy of the Oppressed,” Freire, P., New York: Pedagogy of the Oppressed,” Freire, P., New York: Continuum, 2002.Continuum, 2002.

The Spirit Catches You and You Fall Down: A Hmong The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and Collision of Two Child, Her American Doctors, and Collision of Two Cultures by Anne FadimanCultures by Anne Fadiman

““Educating for a Change,” Arnold, Burke, James, Educating for a Change,” Arnold, Burke, James, Martin, Thomas, Toronto: BTL, 1991. Martin, Thomas, Toronto: BTL, 1991.

Film: “The Color of Fear,” Butler, R. Stir Fry ProductionsFilm: “The Color of Fear,” Butler, R. Stir Fry Productions Film: “The Way Home,” Butler, S. Oakland, CA.: World Film: “The Way Home,” Butler, S. Oakland, CA.: World

Trust, 2002. Trust, 2002.

Thank You!Thank You!

C. Truth Griffeth, LCSW, CDP, NCACC. Truth Griffeth, LCSW, CDP, NCACNative Instincts Consulting GroupNative Instincts Consulting Group

truth@nativeinstincts.comtruth@nativeinstincts.com(206) 399-5846(206) 399-5846