Cultural Humility in Practice- Reframing the Structural-Bowen Model of Healthcare

Cultural Humility in Practice- Reframing the Structural-Bowen Model of Healthcare

Cultural Competence and Cultural Humility

Advocating for the most marginalized individuals, families, and communities is one of our most important responsibilities as social workers. Our practice settings will not always include working with people from backgrounds and cultures similar to ours. The term cultural competency arose from the idea that providers need to understand cultural differences in order to provide effective care across lines of difference. It was created to promote a more client-centered approach through population diversity awareness. Individuals from historically marginalized communities continue to be less likely to access or receive needed services due to a lack of culturally appropriate service provision (Fisher-Borne et al., 2015, as cited in Hausmann et al., 2011; Paradies, 2006), and if services are rendered, they are of lower quality than services received by their White counterparts (Fisher-Borne et al., 2015, as cited in Hausmann et al. Fisher-Borne et al. (2015) describe cultural humility as an alternative framework that could challenge individual practitioners and institutions to address systematic inequalities further. The authors agree that there is more to explore in the conceptualization of cultural humility and propose a conceptual model for cultural humility that could include strategic ways to incorporate cultural humility into social work supervision and education.

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Differences in Cultural Competence and Cultural Humility

Cultural competency has been linked to terms in social work such as cultural awareness, cross-cultural social work, and ethnic competency. According to Fisher-Borne et al. (2015), cultural competency is “a set of attitudes, skills, behaviors, and policies that enable individuals and organizations to establish effective interpersonal and working relationships that transcend cultural differences” (as cited in Cross et al. 1989, p.3). While many professional mandates call for the use of cultural competency as a “standard of care” within educational objectives, there have been growing challenges to the term’s explicit and implicit assumptions.

Tervalon and Murray-Garcia (1998) define cultural humility as “a process of committing to an ongoing relationship with patients, communities, and colleagues that requires humility as individuals continually engage in self-reflection and self-critique.” Fisher-Borne et al. (2015), page 171. Fisher-Borne et al. (2015) highlight the fundamental distinction between cultural competency and cultural humility. While cultural competency seeks to address systematic disparities through knowledge acquisition, cultural humility emphasizes the importance of individual and institutional accountability in confronting those same disparities (p. 172). The authors break down four major criticisms of cultural competency frameworks, which are as follows:

(a) the emphasis on “comfort with others” as a proxy for minority racial/ethnic group identity; (b) the use of “culture” as a proxy for minority racial/ethnic group identity; (c) the emphasis on attempting to “know” and become “competent” in understanding another’s culture or cultures; and (d) the absence of a transformative social justice agenda that addresses and challenges social inequalities (Fisher-Borne et al., 2015, p 169)

Using these criticisms of cultural competency as a guide, one can see how cultural humility differs from the term and can advance as an alternative framework to implement in practice, teaching, and supervision.

Self-Awareness Framed as ‘Comfort with Others’

The framework of cultural competency’s effort to promote self-awareness and reflection among practitioners may be viewed as lacking a critical component required to account for the reality of current inequalities and power imbalances between providers and clients. According to Fisher-Borne et al. (2015), exposing providers to different cultural groups does not necessitate an individual reflecting on potential personal discriminatory values and privileges (p. 169-170). The framework of cultural humility differs from this in that it emphasizes the importance of understanding the ‘other’ and oneself. For example, an ethnocentric practitioner who is part of the dominant mainstream culture may benefit from practicing cultural humility in order to recognize implicit biases toward clients of different cultures and backgrounds that cross over into the services they provide. The framework of cultural humility requires practitioners to make critical self-reflection a requirement rather than an option for the sake of comfort.

As a proxy for minority racial/ethnic group identity, ‘culture.’

According to Fisher-Borne et al. (2015), a common criticism of cultural competency is that culture is used as a “proxy” for non-white racial identity (p. 170). The authors go on to say that treating other socio-demographic characteristics as secondary to racial identity is oppressive because it prevents people from defining their own core identities or emphasizing the intersectionality of complex identities (p. 170). Cultural humility, on the other hand, takes into account the complexities, fluidity, and subjectivity of culture and calls for accountability to eliminate inequalities within structural forces (Fisher-Borne et al., 2015, p.171). In the medical field, for example, healthcare disparities are frequently not adequately addressed because other complex realities, such as poverty, violence, and racism, are viewed as secondary to an individual’s primary identity.

Emphasis on Becoming “Competent” or “Mastering” Cultural Understanding

Cultural competency frameworks place an overabundance of emphasis on the competence of various cultural identities while failing to ensure an understanding of the life experiences of individuals we serve in practice. This strategy of dominant groups “mastering” knowledge of non-dominant groups offers the assumption that various non-dominant groups’ cultural identities and experiences are a collective entity, which often leads to the formation of a collection of negative stereotypes between “us” versus the “other.” Fisher-Borne et al. (2015) emphasize the importance of cultural competency frameworks in continuing to fundamentally change the way we think about, understand, and interact with the world around us (as cited in Dunn, 2002, p. 107). Fisher-Borne et al. (2015) present a cultural humility model that includes the core elements of individual and institutional accountability toward an ongoing learning process and self-reflection. Incorporating cultural humility-based principles that focus on practitioners’ self-awareness in required training could lead to more positive encounters between practitioners and clients, as well as acceptance of differences. Simultaneously, developing workplace policies and procedures through a culturally humble lens could aid in recognizing and addressing harmful power imbalances.

There is a lack of a transformative social justice agenda that addresses social inequalities.

According to Fisher-Borne et al. (2015), “learning a group’s history is seen as sufficient, with little need to strive for social justice in order to eliminate oppression” (p. 170). While cultural competence has raised awareness of the lack of quality care provided to historically marginalized communities, systematic barriers to social equality in those communities have yet to be addressed (p. 171). Simply studying and recognizing differences between groups of people does not address the disparities that are deeply rooted in our society’s structures that work to keep the status quo. Cultural humility is an alternative approach that “… recognizes the dynamic nature of culture and challenges barriers that impact marginalized communities on both the individual and institutional levels” (Fisher-Borne et al., 2015, p. 171). For individuals from marginalized communities, the distinction between cultural competency’s emphasis on knowledge acquisition and cultural humility’s emphasis on accountability could mean the difference between life and death. For example, many in the healthcare field are said to be competent in understanding the astronomical mortality rate for pregnant Black women compared to their White counterparts. However, there is still a lack of institutional and individual resistance to systematic power and privilege in this area.

Cultural Competence and Cultural Humility in Relationships with Diverse Groups

I understand the benefits of incorporating both frameworks into my theoretical orientation of ecological systems theory in social work supervision after reviewing the foundations of cultural competency and cultural humility. This viewpoint contends that our behaviors are influenced by the various environments we encounter throughout our lives. Incorporating the cultural competency framework of seeking knowledge about individuals who are different from ourselves can improve our ability to begin understanding diverse groups with whom we work on the micro, mezzo, and macro levels of systems in social work. Cultural competency is described as a “cookbook approach” by Fisher-Borne et al. (2015), which I believe could help teach diverse groups in supervision how to begin considering cultural differences. Strategically exploring ways to engage individuals we serve through common social skills like empathy, respect, active listening, communication, and patience, for example, would aid in the development of culturally aware social workers in the field.

During supervision, I could expand on cultural humility’s emphasis on accountability toward recognizing systematic inequalities and challenging power imbalances, building on the “cookbook approach” of cultural competency. Connecting common social work skills like advocacy, critical thinking, and professional commitment to the framework of cultural humility could be a beneficial and creative way for supervisees to explore how to use the term at different levels of the ecological system that they work in. A wrap-up discussion on how applying the terms in our practice can enhance the changes we want to see on individual and institutional levels can be encouraged by asking challenging, reflective questions based on the group’s diverse backgrounds and experiences. Ella Greene-Moton, a community leader, offers a profound perspective on recognizing both terms in practice. She says:

Cultural humility and cultural competence, in my opinion, are not either/or but rather both/and. I define cultural humility as the ability to maintain an interpersonal stance that is other-oriented (or open to others), whereas cultural competence is the ability to interact effectively with people from other cultures—a more learned/taught condition. I take pride in being able to claim both competence and humility, acknowledging both as a lifelong journey with no endpoint. Cultural humility, in my opinion, is a spiritual attribute derived from the ability to be humble and couched in a state of selflessness, whereas cultural competence is dependent on a deliberate engagement in cultural knowledge transfer (Greene-Moton et al., 2020, p. 3)

Instilling in supervisees the importance of exploring the frameworks of cultural competency and cultural humility from the perspective of ecological systems theory would help them advocate for the well-being and fit within multiple areas of the social environment of the individuals and communities they serve.

References

Fisher-Borne, M., Cain, J. M., & Martin, S. L. (2015). From mastery to accountability: Cultural humility as an alternative to cultural competence. Social Work Education, 34(2), 165–181

Greene-Moton, E., & Minkler, M. (2020). Cultural Competence or Cultural Humility? Moving Beyond the Debate. Health Promotion Practice, 21(1), 142–

https://doi.org/10.1177/1524839919884912

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This week, you will create a reference that highlights how the elements of either the structural model or the Bowen model can be viewed from a cultural humility lens. This assignment will require you to think creatively about how parts of the model may or may not fit this lens. Attached is a Word document that you will fill out as you consider the connections with the model that you pick and the way you see humility fitting with this model. , rather a listing of ideas. You can generate complete sentences or understandable “bulleted” lists (just make sure you include enough information so that your professor understands the point that you are making).

Cultural Competence and Cultural Humility

You may utilize the presented articles here, information outside of this course (including resources from previous courses), or other information/research from the library to complete the document.

Length: 3 p (filled out worksheet)

References: Include a minimum of 4 scholarly resources.