What does it mean to be culturally competent?

Cultural competence is about our will and actions to build understanding between people, to be respectful and open to different cultural perspectives, strengthen cultural security and work towards equality in opportunity. Relationship building is fundamental to cultural competence and is based on the foundations of understanding each other’s expectations and attitudes, and subsequently building on the strength of each other’s knowledge, using a wide range of community members and resources to build on their understandings.[3]

In Canada, we have talked for a long time about the importance of respecting diversity and embracing a range of cultures as part of the social fabric of our society. However the term, cultural competence, is a relatively new concept to many. So what does cultural competence mean and why is it so important for people to have their culture and cultural backgrounds acknowledged, respected and valued?

Cultural sensitivity is not limited to one group but applies to all cultures. All service providers must avoid using their own group as the standard by which to assess appropriate behavior in others. In addition, greater differences may exist within the same cultural group than between different cultural groups, and we need to be intraculturally sensitive as well as multiculturally sensitive[1].

Underlying cultural competence are the principles of trust, respect for diversity, equity, fairness, and social justice. Culture is the fundamental building block of identity and the development of a strong cultural identity is essential to an individual’s healthy sense of who they are and where they belong [4].

Culture is defined as “the attitudes, habits, norms, beliefs, behaviours, customs, rituals, styles and artifacts that express a group’s adaptation to its environment; that is, ways that are shared by group members and passed on over time” [7]. Culture, similar to an iceberg, represents external and internal dimensions. Most obvious are the external expressions reflected in customs, rituals, and styles. But the internal dimensions, which are the focus of service providers, include awareness of the attitudes, habits, norms, and both spoken and unspoken rules within a particular culture [7]. Cultural competency includes service providers’ awareness of their own cultural iceberg and the working to understanding the cultural iceberg of others.

Cultural competency is more than being aware of cultural differences and is more than knowledge of the customs and values of those different from our own. It goes beyond being respectful of the cultures represented in the service or even the community.

The Iceberg Concept of Culture

Like an iceberg, nine-tenths of culture is below the surface.

Surface Culture

Most easily seen, require low emotional level to comprehend

Examples: Food, dress, music, visual arts, drama, crafts, dance, literature, language, celebrations, games

Shallow Culture

Unspoken rules, require high emotional level to comprehend

Deep Culture

Unconscious rules, require intense emotional level to comprehend

Examples -Moving from Shallow to Deep Culture Understanding: courtesy, contextual conversation patterns, concept of time, personal space, rules of conduct, facial expressions, nonverbal communication, body language, touching, eye contact, patterns of handling emotions, notions of modesty, concept of beauty, courtship practices, relationships to animals, notions of leadership, tempo of work, concepts of food, ideals of child rearing, theory of disease, social interaction rate, nature of friendships, tone of voice, attitudes toward elders, concept of cleanliness, notions of adolescence, patterns of group decision-making, definition of insanity, preferences for competition or cooperation, tolerance of physical pain, concept of “self”, concept of past and future, definition of obscenity, attitudes towards dependents, problems solving roles in relation to age, sex, class, occupation, kinship etc.

Cultural encapsulation

Having a limited understanding of other cultures can lead to cultural tunnel vision, a perception of reality based on a very limited set of cultural experiences. This increases the likelihood of imposing our values on clients by assuming that everyone shares these values. If this happens our services will be unresponsive to the needs of clients and clients will be unresponsive to our services [1]. Cultural encapsulation happens when we:

  • Define reality according to one set of cultural assumptions

  • Show insensitivity to cultural variations among individuals

  • Accept unreasoned assumptions without proof or ignore proof because that might disconfirm our assumptions

  • Fail to evaluate other viewpoints and make little attempt to accommodate the behavior of others

  • Are trapped in one way of thinking that resists adaptation and rejects alternatives

Cultural competence is the ability to understand, communicate with and effectively interact with people across cultures. Cultural competence encompasses:

  • being aware of our own world view: A good place to begin to develop a multicultural perspective is by becoming more aware of your own culturally learned assumptions, some of which may be culturally biased

  • developing positive attitudes towards cultural differences

  • gaining knowledge of different cultural practices and world views

  • developing skills for communication and interaction across cultures.[6]

Cultural proficiency “requires more than becoming culturally aware or practicing tolerance”. Rather, it is the ability to “identify and challenge one’s own cultural assumptions, values and beliefs, and to make a commitment to communicating at the cultural interface”.[8] Principles relevant to cultural competence include fostering secure, respectful and reciprocal relationships, partnerships, high expectations and equity and respect for diversity. We are all are born belonging to a culture, which is not only influenced by traditional practices, heritage and ancestral knowledge, but also by the experiences, values and beliefs of individual families and communities. Respecting diversity means valuing and reflecting the practices, values and beliefs of families and communities.

 

What does cultural competence look like in practice?

Service providers who are culturally competent respect multiple cultural ways of knowing, seeing and living, celebrate the benefits of diversity and have an ability to understand and honour differences. In practical terms, it is a never ending journey involving critical reflection, and learning to understand how people perceive the world and participate in different systems of shared knowledge. Cultural competence is not static, and our level of cultural competence changes in response to new situations, experiences and relationships. The three elements of cultural competence are [1, 9]:

  • Awareness or attitudes

  • Knowledge

  • Skills

 

Awareness:

  1. We move from being culturally unaware to being aware and sensitive to our own cultural heritage and to valuing and respecting differences.

  2. We are aware of our own values and biases and of how they may affect diverse clients.

  3. We are comfortable with differences that exist between ourselves and our clients in terms of race, gender, sexual orientation, and other sociodemographic variables. Differences are not seen as deviant.

  4. We are sensitive to circumstances (personal biases; racial, gender, and sexual orientation identity; sociopolitical influences, etc.) that may dictate referral of clients to members of their own sociodemographic group or to different therapists in general. 5. We are aware of our own racist, sexist, heterosexist, or other detrimental attitudes, beliefs, and feelings.

 
 

Knowledge:

  1. We are knowledgeable and informed about a number of culturally diverse groups, especially the groups we are most likely to work with.

  2. We are knowledgeable about the social and political factors in Canada that influence the treatment of marginalized groups.

  3. We are knowledgeable about institutional barriers such as racism that prevent some diverse clients from accessing social services, privileges and advantages.

 
 

Skills:

  1. We are able to generate a wide variety of verbal and nonverbal culturally sensitive responses.

  2. We are able to communicate (send and receive both verbal and nonverbal messages) accurately and appropriately.

  3. We are able to anticipate impact of our service delivery and our limitations on culturally diverse clients.

  4. We are able to communicate in easy to understand language that is linguistically and culturally appropriate when working with diverse clients.

 

Cultural competence operates at three levels in our work:

  1. The individual level encompasses – the knowledge, skills, values, attitudes and behaviors of individual service providers.

  2. The service level encompasses – management and operational frameworks and practices, expectations, including policies, procedures, vision statements and the inclusion of voices of children, families and communities.

  3. The system level encompasses – how services relate to and respect the rest of the community, agencies, Elders, and local community protocols.

While there is no checklist to tick off to identify culturally competent service providers, we can start to build a picture of the attitudes, skills and knowledge required. For example, service providers who respect diversity and are culturally competent:

  • have an understanding of, and honour, the histories, cultures, languages, traditions, child rearing practices

  • value individual’s different capacities and abilities

  • respect differences in families’ home lives

  • recognise that diversity contributes to the richness of our society and provides a valid evidence base about ways of knowing

  • demonstrate an ongoing commitment to developing our own cultural competence in a twoway process with families and communities

  • promote greater understanding of Indigenous ways of knowing and being

  • engage in ongoing reflection relating to our cultural competence

 
 

Three-Tiered Competence Framework

A three-tiered competence framework that describes varying levels of competence beginning at a pre-competent level, moving to a competent level, and then a proficient level. In this framework, a pre-competent level describes a professional who is aware that competence is important but who is unable to implement cultural awareness, knowledge, and skill in practice. Competent professionals demonstrate skills to effectively intervene in culturally appropriate ways in a particular circumstance. Professionals who demonstrate a stable set of skills, awareness, and knowledge consistently over time and circumstances are be considered proficient [5].

Social justice approach in multicultural service

Social justice reflects a fundamental valuing of fairness and equity in resources, rights, and treatment for marginalized individuals and groups of people. These are individuals and groups who do not share equal power in society because of their immigration status, racial or ethnic identity, age, socioeconomic status, religious heritage, physical or mental ability, sexual orientation or other difference. To provide socially just services, service providers need to view clients’ culture in relation to the broader mainstream culture that might be discriminatory or biased toward particular cultural groups. This can help us to challenge and address injustices, racism, exclusion and inequity through legislation, awareness raising, rights education and an anti-bias curriculum. Cultural competence reinforces and builds on this social justice work.